新农合重大疾病保障政策评述与实施效果研究

发布时间：2018-06-18 01:12

本文选题：新农合 + 重大疾病保障　；参考：《北京协和医学院》2014年硕士论文

【摘要】：目的：厘清新农合大病保障政策的作用机制,对政策内容和落实现状进行评述,对受益面、补偿情况、患者就医和基金流向等政策实施效果开展定量评价,发现政策实施过程中存在的问题并探讨产生原因,提出相应政策建议,为制度完善提供参考。方法：运用定性研究的思路和方法对政策落实现状进行评述,运用描述性统计分析、单因素和多因素分析方法对政策实施效果开展定量评价。结果：自2010年政策启动,各地纳入保障病种数量及主要政策内容符合国家要求;2012年,全国大病保障受益率为12.45人次/10万参合人口,东部地区是中部和西部地区的2倍以上,北京市高于海南省;20种大病实际补偿比达65.39%,儿童两病等4类大病的实际补偿比超过70%,北京市和海南省5种大病中大部分病种年度人均自付费用未超过当地年人均纯收入,但先天性心脏病、白血病等部分病种的高额医疗费用发生率仍然较高；各地费用支付以按病种付费方式为主,推行按病种付费的海南省大病住院费用实际报销比例明显高于推行按项目付费的北京市；与省级医疗机构相比,乡镇、县、市医疗机构的报销比例分别高出25、13和3.5个百分点,但患者就医仍然主要集中在省市级医疗机构;按照现有筹资规模,以70%保障水平要实现20类大病的全人群覆盖,新农合基金所需的筹资规模占筹资总额的比例达到10.14%,要保证所有患者年度个人自负费用不超过8000元,该比例则达到20.40%。结论：新农合重大疾病保障政策整体推进良好,保障效果明显,但区域间保障待遇存在差异,部分病种患者疾病经济负担仍然较重；按病种付费实施效果明显但支付方式多样性有待探索;不同级别医疗机构补偿比例差异显著,但大病分级诊疗格局仍未形成；大病保障可持续发展仍面临挑战。建议：国家层面提出大病保障实施细则,确保各地政策的相对统一；适当调整补偿方式,促进政策的公平性；探索多种形式的支付方式改革；明确不同级别医疗机构的定位；完善医疗服务监管职责分工和考核机制：合理扩充新农合大病筹资规模,促进保障工作的可持续发展。
[Abstract]:Objective: to clarify the mechanism of the protection policy of NCMS, to comment on the policy content and actualization, and to evaluate quantitatively the effect of the policy implementation, such as benefits, compensation, patients seeking medical treatment and fund flow. This paper finds out the problems existing in the process of policy implementation and probes into the causes, and puts forward corresponding policy suggestions to provide reference for the perfection of the system. Methods: the present situation of policy implementation was reviewed by qualitative research, and the effect of policy implementation was evaluated quantitatively by descriptive statistical analysis, single factor analysis and multivariate analysis. Results: since the launch of the policy in 2010, the number of diseases and the main policy contents were in line with the requirements of the country. In 2012, the benefit rate of ensuring the major illness in the whole country was 12.45 per 100000 people, and the eastern region was more than twice as large as the central and western regions. The actual compensation Prida for 20 major diseases in Beijing is higher than that in Hainan Province (Prida 65.39). The actual compensation ratio for four major diseases, such as two diseases in children, is more than 70. Most of the five major diseases in Beijing and Hainan Province do not exceed the annual per capita net income of the local people. However, the incidence of high medical expenses for some diseases, such as congenital heart disease and leukemia, is still relatively high. The actual rate of reimbursement for hospital expenses for major diseases in Hainan Province, which is based on disease types, is significantly higher than that in Beijing, where payment is made on a project-by-project basis. Compared with provincial medical institutions, the reimbursement rates of township, county, and municipal medical institutions are 2513 and 3.5 percentage points higher than those of medical institutions at the provincial level, respectively. However, patients' access to medical care is still concentrated in provincial and municipal medical institutions. According to the current funding scale, the coverage of the whole population of 20 major diseases should be achieved at the level of 70% guarantee. The scale of funding required for the NRCF to reach 10.14% of the total amount raised, to ensure that all patients' annual personal expenses do not exceed 8000 yuan, the proportion is 20.40 yuan. Conclusion: the major disease protection policy of NCMS is advancing well and the effect is obvious. However, there are differences in the treatment between regions, and the economic burden of some patients is still heavy. The effect of payment according to disease is obvious, but the diversity of payment methods remains to be explored; the proportion of compensation in different levels of medical institutions is significantly different, but the pattern of classification diagnosis and treatment of serious illness is still not formed; the sustainable development of serious illness is still facing challenges. Suggestions: at the national level, we should put forward the detailed rules for implementing the safeguard of serious illness to ensure the relative unity of policies in various regions; adjust the compensation mode appropriately to promote the fairness of the policy; explore various forms of payment reform; clarify the position of medical institutions at different levels; To perfect the division of responsibilities and examination mechanism of medical service supervision: to reasonably expand the scale of financing of the New Rural Cooperative Disease and to promote the sustainable development of the guarantee work.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;R197.1;F323.89

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