新型农村合作医疗保险应对道德风险机制及其对医疗服务利用的影响

发布时间：2018-05-19 12:14

本文选题：道德风险 + 共付制度　；参考：《四川农业大学》2013年硕士论文

【摘要】：“看病贵、看病难”的问题已成为影响居民生活的问题之一,社会医疗保险制度的引入可以部分解决这一问题。但是,医疗保险制度的引入有可能加剧医疗费用支出的增加、造成不必要的医疗资源浪费。为了解决道德风险问题,在对参保患者的补偿方式上通常有共付制度的安排,但共付制度也降低了保险的风险防护功效,对参保患者的健康造成了负面的冲击。我国新型农村合作医疗自2003年开始试点,到近几年的大力推进,新农合在解决农民因病致贫和因病返贫的问题上,发挥了重大的作用。但是,近年来的实践也暴露了新农合制度设计和治理结构的缺陷,如道德风险和供方诱导造成的对医疗服务的过度需求。在新农合的不断上涨的医疗费用和农民受益比例之间找到一种平衡,对新农合的健康持续发展十分必要。本文在医疗保险需求理论、健康经济学相关理论、福利经济学和卫生经济学相关理论的基础上,通过总结国内外医疗保险中的道德风险问题,借鉴社会医疗保险的相关理论实践,对保险中的道德风险产生原因、应对机制进行了理论分析。在新农合的统筹补偿制度调整和农民受益关系及医疗服务利用的问题上,利用中西部36个调查县2008-2010年的新农合机构的调研数据和四川省366户农民的个体样本数据,运用广义线性回归模型对新农合的不同调查县的农民补助受益比例的影响因素进行分析,使用多元线性回归模型和logistic模型对农民的医疗服务利用影响因素进行分析。研究发现了经济因素对新农合补偿受益比例和医疗服务费用率影响显著、住院和门诊统筹补偿模式适宜现阶段新农合的发展、起付线和住院补偿比例不同对新农合受益比例有显著影响、农民的个体特征对新农合医疗服务利用影响显著、新农合共付比例的调整和优化对防止道德风险有积极作用。并对研究结果提出了相应的政策建议：逐步减少家庭账户补偿模式,引导补偿模式向住院和门诊统筹转变；合理设置住院补偿方案,有效提高患者保障力度；提高筹资水平,进一步扩大新农合补偿面；深化医疗服务质量的管理,提高农村医疗服务资源的利用度；加大农村公共卫生投入,提供免费体检,提高农户健康水平；促进农村基层医疗机构发展,为农民就医提供便利。
[Abstract]:The problem of "expensive to see a doctor, difficult to see a doctor" has become one of the problems affecting residents' life, and the introduction of social medical insurance system can partly solve this problem. However, the introduction of medical insurance system may aggravate the increase of medical expenses and lead to unnecessary waste of medical resources. In order to solve the moral hazard problem, there is usually the arrangement of co-payment system in the way of compensation for insured patients, but the co-payment system also reduces the risk protection effect of insurance, which has a negative impact on the health of insured patients. The New Rural Cooperative Medical system (NCMS) in our country has been piloted since 2003, and in recent years, NCMS has played an important role in solving the problems of peasants' poverty caused by illness and returning to poverty because of illness. However, the practice in recent years has also exposed the defects in the design and governance structure of the NCMS system, such as moral hazard and excessive demand for medical services caused by supply-side inducement. It is necessary to find a balance between the rising medical expenses of NCMS and the ratio of farmers' benefits to the healthy and sustainable development of NCMS. Based on the theories of medical insurance demand, health economics, welfare economics and health economics, this paper summarizes the moral hazard in medical insurance at home and abroad. Based on the theory and practice of social medical insurance, this paper analyzes the reason and mechanism of moral hazard in insurance. With regard to the adjustment of the overall compensation system of NCMS, the relationship between farmers' benefits and the utilization of medical services, the survey data from 36 survey counties in central and western China from 2008 to 2010 and individual sample data from 366 farmers in Sichuan Province were used. Based on the generalized linear regression model, the factors influencing the benefit ratio of farmers' subsidy in different counties were analyzed, and the influencing factors of farmers' medical service utilization were analyzed by using multiple linear regression model and logistic model. It is found that the economic factors have a significant impact on the benefit ratio of NCMS and the rate of medical service cost, and the in-patient and out-patient compensation model is suitable for the development of NCMS at the present stage. The difference of starting line and hospitalization compensation ratio has significant influence on the benefit ratio of NCMS, the individual characteristics of farmers have a significant influence on the utilization of NCMS medical service, and the adjustment and optimization of NCMS's co-payment ratio has a positive effect on preventing moral hazard. And put forward the corresponding policy suggestions to the research results: gradually reduce the family account compensation model, guide the compensation model to the in-patient and out-patient coordination, set up a reasonable hospitalization compensation program, effectively improve the patient protection, raise the level of financing. Further expand the compensation area of NCMS, deepen the management of medical service quality, improve the utilization of rural medical service resources, increase rural public health investment, provide free physical examination, improve the health level of rural households; To promote the development of primary-level medical institutions in rural areas and provide convenience for farmers to seek medical treatment.
【学位授予单位】：四川农业大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;F842.684;R197.1

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