鄂尔多斯市新型农村合作医疗市级统筹发展战略研究

发布时间：2018-05-09 16:12

本文选题：新型农村合作医疗 + 市级统筹　；参考：《内蒙古大学》2013年硕士论文

【摘要】：新型农村牧区合作医疗(以下简称新农合)是我国新形势下农村牧区社会保障制度中的一项重要内容。它的深入推进在一定程度上缓解了“看病难、看病贵”的问题,有效地遏制了部分农牧民群众因病致贫、因病返贫的现象,但随着制度的进一步发展,也出现许多新的问题,如基金风险分担能力差、管理成本高昂、异地报销困难,受益的公平性较差,容易对新农合产生误解等,因此有必要提高新农合的统筹层次。市级统筹是保险学追寻大数法则以及基本公共服务均等化内在要求。大数法则可通过扩大群众受益的覆盖面与提高统筹层次这两种途径实现。目前,全国的扩面工作基本完成,实施市级统筹是未来新农合发展的必然趋势。因此,应该在鄂尔多斯市范围内实施新农合市级统筹。本文将理论结合实证进行研究,阐述了鄂尔多斯市新农合的现状及存在的问题,并深入地调查鄂尔多斯市新农合的运行绩效,县级统筹存在问题,同时对鄂尔多斯市新农合市级统筹运行模式进行分析,通过横向(与全国、全自治区的比较；与当地城镇居民医保的比较)、纵向(县级统筹的市级统筹比较)的比较,从而得出鄂尔多斯市实施新农合市级统筹的优越性,不仅筹资水平高,报销比例大,受益人次数多,而且进一步体现了保险的公平性,统筹后的便民性。本文进一步对鄂尔多斯市新农合运行进行SWOT分析,根据鄂尔多斯市实施市级统筹的发展机会,主要是政策环境良好、政府责任加大、人力资源有保障；实施市级统筹的外部威胁,主要是医药费用上涨快、各旗区经济不平衡、财政较困难；利用实施市级统筹的优势,如六统一政策实施、参合农牧民收益率高、抗风险能力强等；避免实施市级统筹的劣势,如具体制度设计不成熟、医疗服务提供与费用控制矛盾、监管不能及时到位。利用SWOT分析找出一条最合适、最科学的鄂尔多斯市新农合发展道路,达到趋利避害、充分发展的目的。鄂尔多斯市市级统筹政策宜采取中等发达地区的WO和ST策略,并通过“六个统一”使得该策略实施,即：统一筹资标准、统一组织管理、统一基金管理、统一补偿标准、统一服务监管、统一信息化管理。鄂尔多斯市新农合市级统筹的顺利实施,需要政府部门给予支持,需要建立稳定的筹资机制、通过多种手段提高农民的受益程度、提高基层医疗卫生服务质量、商业保险参与新农合运作、进一步加强新农合定点医疗机构的监管。
[Abstract]:The new cooperative medical system in rural pastoral areas (hereinafter referred to as NCMS) is an important part of social security system in rural pastoral areas under the new situation in our country. Its further promotion alleviates to a certain extent the problem of "difficult and expensive to see a doctor," and effectively restrains the phenomenon of some farmers and herdsmen returning to poverty as a result of illness. However, with the further development of the system, many new problems have also emerged. If the fund's risk sharing ability is poor, the management cost is high, it is difficult to reimburse in different places, the fairness of benefit is poor, and it is easy to misunderstand NCMS, so it is necessary to improve the overall planning level of NCMS. City-level planning is the inherent requirement of the pursuit of the law of large numbers and the equalization of basic public services. The law of large numbers can be realized by expanding the coverage of the benefit of the masses and improving the overall level. At present, the expansion of the country is basically completed, the implementation of the city-level coordination is the inevitable trend of the development of new agricultural cooperation in the future. Therefore, it should be in Ordos City to implement the new agricultural cooperation city-level coordination. In this paper, the current situation and existing problems of NCMS in Ordos are expounded, and the operational performance of NCMS in Ordos is investigated deeply, and the existing problems at county level are also discussed in this paper. At the same time, through the analysis of the overall operation mode of the new agricultural cooperation in Ordos, the paper compares the horizontal (compared with the whole country and the whole autonomous region; the comparison with the local urban residents' medical insurance; the vertical (the county level as a whole); Therefore, it is concluded that Ordos City has the superiority of implementing the new rural cooperative planning, which not only has a high level of financing, a large proportion of reimbursement, many times of beneficiaries, but also further reflects the fairness of insurance, and the convenience after planning. This article further carries on the SWOT analysis to the Ordos new agriculture cooperation movement, according to the Ordos city implements the city overall plan development opportunity, mainly is the policy environment is good, the government responsibility increases, the human resources has the safeguard; The external threats to the implementation of the overall planning at the municipal level are mainly the rapid rise of medical expenses, the imbalance in the economy of the flag areas and the difficulty in finance, and the utilization of the advantages of the implementation of the overall plan at the municipal level, such as the implementation of the six unified policies, the high rate of return of participating farmers and herdsmen, and the strong ability to resist risks, etc. To avoid the disadvantages of implementing municipal overall planning, such as the immaturity of specific system design, the contradiction between medical service provision and cost control, and the lack of timely supervision. SWOT analysis is used to find out the most suitable and scientific way for the development of the new agricultural cooperation in Ordos, in order to achieve the goal of seeking advantages and avoiding disadvantages and fully developing. In Ordos city, WO and St strategies should be adopted in the middle developed areas, and through "six unification", the strategy should be implemented, that is, unified financing standard, unified organization management, unified fund management and unified compensation standard. Unified service supervision, unified information management. The smooth implementation of the new rural cooperative plan in Ordos requires the support of government departments, the establishment of a stable financing mechanism, the improvement of farmers' benefit through various means, and the improvement of the quality of primary medical and health services. Commercial insurance participate in the operation of NCMS, and further strengthen the supervision of NCMS designated medical institutions.
【学位授予单位】：内蒙古大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684;F323.89;R197.1

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