新型农村合作医疗基金监管有效性评价研究

发布时间：2018-06-19 14:18

本文选题：新型农村合作医疗基金 + 监管有效性　；参考：《山东农业大学》2013年硕士论文

【摘要】：新型农村合作医疗制度实施以来，在保障农民获得基本卫生服务、缓解农民因病致贫和因病返贫方面发挥了重要的作用。但在新型农村合作医疗制度运行过程中，违规征缴参合费用和套取基金的情况不断出现，凸显出对新型农村合作医疗基金进行有效监管的必要性和紧迫性。本文以此为背景，围绕新型农村合作医疗基金监管有效性评价指标体系构建、方法选定及其应用等问题展开具体研究，对提高新型农村合作医疗基金监管的有效性将会起到重要的推动作用。论文共分为七章，第一章为导论，第二章为基础研究，主要包括相关概念界定和理论基础；第三至六章为本文的主要部分，涉及了新型农村合作医疗基金监管有效性指标体系的构建、评价方法的选定、实证分析及相应建议；第七章对全文的研究进行了总结并提出了尚待研究之处。本文的主要研究结论有：（1）在明确新型农村合作医疗基金监管有效性基本内涵与理论基础的基础上，阐明了新型农村合作医疗基金监管有效性评价的功能，即描述功能、分析和评价功能、监督功能、引导功能；并且设计了新型农村合作医疗基金监管有效性评价的步骤。（2）在阐明构建新型农村合作医疗基金监管有效性评价指标体系的目标与基本原则的基础上，，运用德尔菲专家咨询法筛选指标、运用带有专家可信度的层次分析法确定指标权重，最终形成了完整的新型农村合作医疗基金监管有效性评价指标体系，包括3个一级指标、6个二级指标、26个三级指标，通过分析认为指标覆盖内容全面、建立指标方法合理、权重计算准确。（3）在阐明新型农村合作医疗基金监管有效性评价方法的选择原则之后，对现代几种典型的综合评价方法如数据包络分析法、人工神经网络法、灰色综合评价法、模糊综合评价法的优缺点及适用场合进行了比较，认为新型农村合作医疗基金监管有效性评价过程将涉及到大量复杂情况和许多不易进行定量的因素，对它们的评价分级没有绝对明确的界限，具有模糊性，使用其他三种评价方法存在着不合理性，而模糊综合评价法能够将不易定量的因素通过模糊数学的隶属度理论予以定量化，可以较为系统全面的解决这一问题，故选定模糊综合评价法作为适宜方法，进而根据新型农村合作医疗基金监管有效性评价指标体系的设计，阐述了模糊综合评价法的计算过程。（4）利用新型农村合作医疗基金监管有效性评价指标体系和模糊综合评价法，对潍坊市青州市、济宁市汶上县和枣庄市市中区进行了评价，计算出三个县市新型农村合作医疗基金监管有效性综合评价值分别为17.544，16.024，17.504，即三个县市中，潍坊市青州市新型农村合作医疗基金监管有效性最强，枣庄市市中区次之，济宁市汶上县新型农村合作医疗基金监管有效性最弱。同时也对三个地区的监管能力、监管效率、满意度综合评价得分进行了横向比对，找出造成新型农村合作医疗基金监管有效性强弱的关键因素包括信息化管理率、执法取证设备配备率、监管工作执行等。（5）针对新型农村合作医疗基金监管有效性评价指标体系的设计和实例分析中暴露的问题，结合新型农村合作医疗基金监管的实际情况提出了具体建议。提升新型农村合作医疗基金监管有效性的建议主要有：完善新型农村合作医疗基金监管制度和体系、加强新型农村合作医疗基金监管队伍建设、加强新型农村合作医疗基金监管信息化建设以提升监管部门的监管能力；强化风险意识，克服冒险行为、积极开展现场检查、加大对定点医疗机构处罚力度以提升监管部门的监管效率；建立信息披露制度、建立多层次的信息发布渠道、建立投诉举报制度和监管激励机制以提升监管的满意度。另外，还应采取建立健全基层经办机构建设、推行乡级新型农村合作医疗经办机构人员县级垂直管理、开展“新型农村合作医疗诚信医院”创建活动等措施作以辅助。
[Abstract]:Since the implementation of the new rural cooperative medical system, it has played an important role in guaranteeing farmers' basic health services, alleviating farmers from getting poor and returning to poverty because of the disease. However, during the operation of the new rural cooperative medical system, illegal collection and collection of fees and funds are constantly emerging, which highlights a new rural cooperative medical service. It is necessary and urgent for the effective supervision of the treatment fund. This paper takes this as the background, and focuses on the construction of the evaluation index system of the new rural cooperative medical fund supervision effectiveness evaluation system, the selection of methods and its application and so on, which will play an important role in promoting the effectiveness of the new rural cooperative medical fund supervision.
The thesis is divided into seven chapters. The first chapter is the introduction, the second chapter is the basic research, which mainly includes the definition and the theoretical basis of the related concepts; the third to the six chapter is the main part of this article, which involves the construction of the new rural cooperative medical fund supervision effectiveness index system, the selection of evaluation methods, the empirical analysis and the corresponding suggestions; the seventh chapter is the whole system. This paper summarizes the research and puts forward some points for further study.
The main conclusions of this paper are as follows:
(1) on the basis of clarifying the basic connotation and theoretical basis of the effectiveness of the new rural cooperative medical fund supervision, this paper expounds the function of the evaluation of the effectiveness of the new rural cooperative medical fund supervision, that is to describe the function, the function of analysis and evaluation, the function of supervision and the function of guidance, and the effectiveness evaluation of the new rural cooperative medical fund supervision is also designed. The steps.
(2) on the basis of clarifying the objectives and basic principles of establishing the evaluation index system for the effectiveness of the new rural cooperative medical fund supervision, using the Delphy expert consultation method, the index is selected and the index weight is determined by the analytic hierarchy process with the credibility of the expert. Finally, the evaluation of the effectiveness of the new rural cooperative medical fund is formed. Price index system, including 3 first grade index, 6 two grade index and 26 three grade index. Through the analysis, the index covers the overall content, the establishment of the index method is reasonable, the weight calculation is accurate.
(3) after clarifying the selection principle of the effectiveness evaluation method of the new rural cooperative medical fund supervision, this paper compares the advantages and disadvantages of several modern typical comprehensive evaluation methods, such as data envelopment analysis, artificial neural network, grey comprehensive evaluation and fuzzy comprehensive evaluation, and thinks that the new rural cooperative medical foundation is the basis of the new rural cooperative medical system. The evaluation process of the effectiveness of gold supervision will involve a large number of complex situations and many factors which are not easy to quantify. There is no absolute definite boundary for their evaluation and classification. It is fuzzy, and the other three kinds of evaluation methods are unreasonable, and the fuzzy comprehensive evaluation method can make the factors which are not easy to be quantified through fuzzy mathematics. The degree theory is quantified and can solve the problem systematically and comprehensively. Therefore, the fuzzy comprehensive evaluation method is selected as the suitable method, and then the calculation process of the fuzzy comprehensive evaluation method is expounded according to the design of the evaluation index system of the new rural cooperative medical fund supervision effectiveness.
(4) using the evaluation index system of the new rural cooperative medical fund supervision effectiveness and the fuzzy comprehensive evaluation method, the evaluation is carried out on Qingzhou city of Weifang, Wenshang County and Zaozhuang city in Jining City, and the comprehensive evaluation value of the supervision effectiveness of the new rural cooperative medical funds in three counties and cities is 17.544,16.024,17.504, that is, three counties. In the city, the new rural cooperative medical fund in Qingzhou city of Weifang is the most effective, the Central District of Zaozhuang city is the second. The effectiveness of the new rural cooperative medical fund in Wenshang County of Jining is the weakest. At the same time, the supervision ability, the supervision efficiency and the comprehensive evaluation score of the three regions are compared, and the new rural areas are found out. The key factors of the effectiveness of the supervision of the cooperative medical fund include the information management rate, the rate of law enforcement evidence collection equipment, and the implementation of supervision work.
(5) in view of the problems exposed in the design and case analysis of the effectiveness evaluation index system of the new rural cooperative medical fund supervision and management, the concrete suggestions are put forward in combination with the actual situation of the new rural cooperative medical fund supervision. The suggestions for improving the effectiveness of the new rural cooperative medical fund supervision are as follows: the improvement of the new rural cooperative medical foundation Gold supervision system and system, strengthen the construction of the new rural cooperative medical fund supervision team, strengthen the construction of the new rural cooperative medical fund supervision information construction to improve the supervision ability of the supervision department, strengthen the risk awareness, overcome the risk behavior, actively carry out the field inspection, and increase the punishment to the designated medical institutions in order to improve the supervision department The system of information disclosure, the establishment of multi-level information distribution channels, the establishment of the complaint reporting system and the supervision and incentive mechanism to improve the satisfaction of the supervision. In addition, the construction of the grass-roots agencies should be established, and the new rural cooperative medical institutions personnel at the county level should be carried out at the county level and the "new type" should be carried out. Measures such as the establishment of a good faith hospital in rural cooperative medical care and so on.
【学位授予单位】：山东农业大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;F842.684;R197.1

【参考文献】