云南省曲靖市麒麟区新农合乡级住院免费医疗运行现状研究

发布时间：2018-04-21 07:44

本文选题：麒麟区 + 新型农村合作医疗　；参考：《昆明医科大学》2014年硕士论文

【摘要】：目的通过分析云南省曲靖市麒麟区新农合乡级住院免费医疗运行现状和乡级住院免费医疗制度的可行性,综合评价乡级住院免费医疗医疗制度实施的成功经验和存在问题,有针对性地提出合理化建议,为有关部门进一步完善新型农村合作医疗制度,建立持续、健康、稳步发展的新型农村合作医疗制度提供科学依据。方法采用流行病学横断面调查进行研究。通过报表和调查表收集麒麟区2012年、2013年的新型农村合作医疗资料；以分层抽样方法抽取东山镇和西城街道2个样本；以问卷调查方式随机抽取2个样本医院和区外定点医疗机构参合的住院患者656人,了解他们对新型农村合作医疗制度补偿方案等的意见和建议；对区乡级新农合管理人员进行访谈。全部资料均采用SPSS统计软件包进行分析。结果 1.曲靖市麒麟区新农合乡级住院运行状况2013年参合患者在乡级定点医疗机构住院治疗住院医药费用按起付线200元,报销比例100%报销,实行现场即时补偿。2013年乡级住院31741人次,占住院总人次的52.25%；住院补偿2779.90万元,占住院补偿总费用的23.55%；乡级住院总费用为3207.21万元,与2012年同期2031.63万元相比,上涨1175.58万元,增长57.86%；次均住院费用为1010.40元,与2012年同期798.90元相比,上涨211.5元,增长26.47%。 2.住院患者对当前就诊医院和乡级住院免费医疗制度基本情况的知晓程度、态度的评价西城街道社区卫生服务中心、东山镇中心卫生院和区外医院的的住院患者对其就诊医院的评价项目都存在统计学差异。65.4%的住院患者对当前就诊医院总体满意。患者对乡级住院免费医疗基本情况知晓程度存在统计学差异,知晓程度最高的是西城社区卫生服务中心住院患者,其次是东山镇卫生院住院患者,区外的住院患者知晓程度最低。 3.对乡级住院免费医疗制度的态度和定点医疗机构变化情况的评价住院患者对麒麟区实施乡级住院免费医疗制度的态度都存在统计学差异,66.6%住院患者支持开展乡级住院免费医疗制度。住院患者对实施乡级住院免费医疗制度后医疗机构整体变化在服务态度、医疗设备、医技水平、服务质量、服务流程的评价都有统计学差异。 4.新农合管理人员对实施乡级住院免费医疗制度的评价新农合管理人员对实施免费医疗制度的态度与参合患者不完全一致,管理人员认为在目前的医疗条件下,实施免费医疗制度最大的困难是政府对基层医疗机构投入不足和卫生技术人员缺乏。从2013年住院病人流向与2012年相比看,通过实施免费医疗制度来控制病人区外就诊率有一定的效果。结论麒麟区新农合乡级住院免费医疗经过一年的运行,住院人次、补偿资金都比2012年增长。从2013年麒麟区住院病人流向与2012年相比看,省、市、乡级住院人次数分别增加了286、2425、6311人次,区级减少491人次,通过实施免费医疗制度来控制病人区外就诊率有一定的效果。但是同时也带来了门诊转住院、小病大养、次均住院费用上涨的问题。随着人均筹资标准逐年提高,在确保基金安全的前提下,适当提高基层医疗机构的报销比例,有利于缓解“看病难”的难题,更多的惠及参合群众,有利于新农合制度持续、健康发展。
[Abstract]:objective
Through the analysis of the current status of the free medical operation in the nncms and the feasibility of the free medical system in the township level in Kirin District, Qujing, Yunnan, the successful experience and problems of the implementation of the free medical system in the township level are comprehensively evaluated, and the rationalization proposals are put forward to improve the new rural cooperation for the relevant departments. To provide a scientific basis for the establishment of a new rural cooperative medical system with continuous, healthy and steady development as a medical system.
Method
The epidemiological cross-sectional survey was used to collect the data of the new rural cooperative medical service in kylin District in 2012 and 2013. 2 samples of Dongshan and Xicheng streets were sampled by stratified sampling method, and 65 hospitalized patients with 2 sample hospitals and outside fixed-point medical institutions were randomly selected by questionnaire. 6 people know their opinions and suggestions on the compensation scheme for the new rural cooperative medical system, and interview the management personnel of the new rural cooperative medical system in the district. All the data are analyzed by the SPSS software package.
Result
1. the operation status of the NCMS in Kirin District, Qujing, in 2013, the hospitalized medical expenses of the participants in the local medical institutions were 200 yuan, the reimbursement ratio was 100%, 31741 people were hospitalized in.2013 years, accounting for 52.25% of the total number of inpatients and 27 million 799 thousand yuan in hospitalization, which accounted for the hospitalization compensation. The total cost was 23.55%. The total cost of rural hospitalization was 32 million 72 thousand and 100 yuan. Compared with 20 million 316 thousand and 300 yuan in the same period in 2012, the total cost was 11 million 755 thousand and 800 yuan, up 57.86%, and the average hospitalization cost was 1010.40 yuan. Compared with 798.90 yuan in the same period in 2012, it was up 211.5 yuan, up 26.47%.
2. the awareness of the basic situation of the free medical system in the hospitalized hospital and the local hospital, the assessment of the attitude of the Xicheng Street Community Health Service Center, the Central Health Hospital of Dongshan Town and the hospital in the outpatient hospital for the evaluation of the hospitalized hospital, the hospitalized patients with the difference of.65.4% were present for the current medical treatment. The general satisfaction of the hospital was satisfactory. There was a statistical difference between the patients' awareness of the basic situation of free medical care in the township level. The highest awareness was the inpatients in the Xicheng community health service center, followed by the inpatients in the Dongshan Township Hospital, and the lowest level of awareness of the inpatients outside the district.
3. the attitude of the free medical system in the township level and the change of the designated medical institutions, the attitude of the hospitalized patients to the free medical system in the kylin district was statistically different, and 66.6% of the hospitalized patients supported the free medical system in the township level. The overall changes in medical institutions were statistically different in terms of service attitude, medical equipment, medical skill level, service quality and service process.
4. the evaluation of the new rural cooperation management personnel to implement the free medical system at the township level. The attitude of the new rural cooperative management personnel to the implementation of the free medical system is not exactly the same as those of the participants. Under the current medical conditions, managers believe that the biggest difficulty in implementing the free medical system is the insufficient investment and health technology of the government to the grass-roots medical institutions. From 2013, compared with 2012, the implementation of free medical care system has a certain effect in controlling outpatient visits.
conclusion
The free medical treatment of the nncms in Kirin District was run after one year, and the amount of compensation was increased than in 2012. From 2013 to 2012, the number of inpatients in the Kirin District was increased by 28624256311, the district level was 491 times, and the patients were controlled by the free medical system to control the patients. But at the same time, it also brought about the problem of the outpatient transfer to the hospital, the small illness and the increase of the cost of hospitalization. With the increase of the per capita fund raising standard, the proportion of the reimbursement for the medical institutions at the grass-roots level should be properly improved on the premise of ensuring the security of the fund. The masses are conducive to the sustained and healthy development of the new rural cooperative medical system.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F323.89;F842.684

【参考文献】