吉林省新型农村合作医疗发展现状及对策研究
发布时间：2018-07-16 18:46
【摘要】：【研究背景】 从2003年起，新型农村合作医疗制度在全国部分县(市)试点，中央政府根据经济社会发展的差异，，将吉林省作为第一批4个试点省份之一。自新农合开展以来，吉林省在方案设计、制度建设与执行等方面进行了积极的探索，取得了显著的成果，新农合覆盖面不断扩大，参合率不断提高，制度不断巩固和完善，很大程度上改善了农民的就医状况，减轻了参合农民的医疗负担。但是在实施的过程中仍然存在许多问题，为客观、真实、全面、公正的评价吉林省新型农村合作医疗制度的发展状况，找出存在的问题，提出完善吉林省新型农村合作医疗制度的对策与建议，已成为当务之急。 【研究目的】 本文通过吉林省和全国各地区新农合历年数据的横向对比研究，近几年吉林省新农合数据的纵向对比研究，评价吉林省新农合的发展现状，分析发展中存在的问题；借鉴其他国家农村医疗保障制度和国内典型地区新农合发展的经验，提出对吉林省新农合发展有益的对策和建议。 【研究方法】 本研究收集了2007～2012年吉林省新农合相关报表、各项制度政策，参阅了2007～2012年《中国卫生统计年鉴》和《吉林省国民经济和社会发展统计公报》，对吉林省卫生资源状况、新农合开展、基金运行、经办机构建设等情况进行全面的分析和评价，提出新农合运行过程中出现的问题及对策建议。 【研究结果】 1.吉林省人均卫生资源持续增长。2007～2012年，吉林省人均卫生资源量（每千人拥有医疗机构床位数和卫生技术人员）均保持增长趋势，且高于同期全国平均水平，但城乡卫生资源分布不均衡。 2.吉林省新农合自发展以来取得了显著的成果。2007～2012年，参合人数由1046.8万人增加到1328.2万人，参合率由82.1%增加到99.4%，筹资总额由53656.5万元增加到386000.0万元、人均筹资额由51.3元增加到290.6元，但人均筹资额低于全国平均水平。门诊实际补偿比、住院实际补偿比、补偿封顶线均有显著提高。2012年门诊实际补偿比和住院实际补偿比分别为37.0%和52.5%，分别比2007年提高了15.3%和23.5%，但低于同期全国平均水平；补偿封顶线由2007年的3万元提高到2012年的8万元，个别地区达到了10万元。 3.县级经办机构每实有人员管理参合人数较大，且各地区之间差距较大。2011年，吉林省县级经办机构平均每实有人员管理参合人数为24112.1，最大的榆树市为140651，最小的吉林市高新区为1263，两者相差111.4倍。 4.参合患者在县级以上医疗机构住院费用较高。2012年，次均住院费用为10009.1元，次均自费费用为5686.2元，占当年农民人均纯收入的66.1%。 5.参合患者选择在县级医疗机构和县级以上医疗机构住院的比重呈上升趋势，在乡镇级医疗机构住院的比重不断下降。2007～2012年，县级医疗机构住院人次占住院总人次的比例由45.6%上升到54.1%，县级以上医疗机构由18.4%上升到30.4%，乡镇级医疗机构由36.0%下降到15.5%。 【研究结论】 吉林省新农合制度自开展以来，运行平稳，并取得了显著的成果。但也存在着一些问题。第一，筹资标准的确定欠科学且筹资渠道单一。第二，对于基金的使用缺乏合理的预算。第三，门诊统筹发展较慢。第四，县级经办机构配备工作人员数量不合理。第五，住院就医流向不合理，且有逐年加重的趋势。
[Abstract]:[research background]
Since 2003, the new rural cooperative medical system has been pilot in some counties (cities) in the country. According to the differences in economic and social development, the central government has taken Jilin as one of the first 4 pilot provinces. Since the development of the new agricultural cooperation, the Jilin province has made a positive exploration in the design of the scheme, the construction and implementation of the system, and has made remarkable achievements. With the expansion of the coverage of the NCMS, the continuous improvement of the participation rate and the continuous consolidation and improvement of the system, the medical conditions of the farmers were improved to a great extent and the medical burden of the farmers were reduced. However, there are still many problems in the process of implementation, and the new rural cooperative medical system in Jilin province is evaluated objectively, truly, completely and impartially. The development situation, finding out the existing problems and putting forward the countermeasures and suggestions to improve the new rural cooperative medical system in Jilin have become a top priority.
[purpose]
In this paper, through the comparative study of the data of the new rural cooperation years in Jilin and the whole country, the longitudinal comparison of the new agricultural cooperation data in Jilin Province in recent years, evaluation of the development status of the new agricultural cooperation in Jilin Province, the analysis of the existing problems in the development, and the experience of the rural medical security system in other countries and the development of the new agricultural cooperation in the typical areas of the country. Some useful countermeasures and suggestions are put forward for the development of Jilin new rural cooperative medical system.
[research methods]
In this study, the report of the new agricultural cooperation (nncms) in Jilin province was collected for 2007~2012 years, and the system policies were collected, and the 2007~2012 year "China Health Statistics Yearbook" and "the national economic and social development statistical bulletin of Jilin province" were reviewed. The situation of the health resources in Jilin Province, the development of the new agricultural cooperation, the operation of the fund and the construction of the agencies were reviewed and reviewed. Price, put forward the problems and Countermeasures in the operation of the new rural cooperative medical system.
[results]
1. the per capita health resources in Jilin province continued to increase from.2007 to 2012. The per capita health resources in Jilin province (each thousand people with medical institutions and health technicians) kept growing, and higher than the national average in the same period, but the distribution of urban and rural health resources was uneven.
2. since the development of NCMS in Jilin province has achieved remarkable results since its development from.2007 to 2012, the number of participants increased from 10 million 468 thousand to 13 million 282 thousand, the rate of participation increased from 82.1% to 99.4%, the total amount of financing increased from 536 million 565 thousand yuan to 3 billion 860 million yuan, and the per capita financing amount increased from 51.3 yuan to 290.6 yuan, but the per capita fund-raising was lower than the national average. The actual compensation ratio, the actual compensation ratio in the hospital and the compensation capping line significantly improved the actual compensation ratio and the actual hospitalization compensation ratio of 37% and 52.5% in.2012 years, respectively, increased by 15.3% and 23.5% in 2007, respectively, but lower than the national average in the same period; the compensation capping line was raised from 30 thousand yuan in 2007 to 80 thousand yuan in 2012, in some areas. Up to 100 thousand yuan.
3. the number of personnel management participation in the 3. county-level agencies is larger, and the gap between the regions is larger in.2011 years. The average number of personnel management participation in the county level agencies in Jilin province is 24112.1, the largest elm city is 140651, the smallest Jilin high tech Zone is 1263, and the difference between the two is 111.4 times.
4. the hospitalization expenses of the medical institutions at the county level above the county level were higher for.2012 years, and the average cost of hospitalization was 10009.1 yuan, and the cost of self-charge was 5686.2 yuan, which accounted for 66.1%. of the per capita net income of the year.
5. the proportion of hospitalized patients in county-level medical institutions and medical institutions above the county level is on the rise. The proportion of hospitalization in township level medical institutions is decreasing from.2007 to 2012. The proportion of inpatients in the county level medical institutions increased from 45.6% to 54.1%, and the medical institutions above the county level increased from 18.4% to 30.4%. The level of medical institutions dropped from 36% to 15.5%.
[Conclusion]
Since the new rural cooperative system of Jilin province has been carried out, its operation has been smooth and remarkable achievements have been achieved. However, there are also some problems. First, the financing standards are not scientific and the financing channels are single. Second, the lack of reasonable budget for the use of funds. Third, the overall development of out-patient services is slow. Fourth, county-level agencies are equipped with the number of staff. Unreasonable. Fifth, the inflow of hospitalization is unreasonable, and there is a trend of increasing year by year.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F323.89;F842.684
本文编号：2127299
[Abstract]:[research background]
Since 2003, the new rural cooperative medical system has been pilot in some counties (cities) in the country. According to the differences in economic and social development, the central government has taken Jilin as one of the first 4 pilot provinces. Since the development of the new agricultural cooperation, the Jilin province has made a positive exploration in the design of the scheme, the construction and implementation of the system, and has made remarkable achievements. With the expansion of the coverage of the NCMS, the continuous improvement of the participation rate and the continuous consolidation and improvement of the system, the medical conditions of the farmers were improved to a great extent and the medical burden of the farmers were reduced. However, there are still many problems in the process of implementation, and the new rural cooperative medical system in Jilin province is evaluated objectively, truly, completely and impartially. The development situation, finding out the existing problems and putting forward the countermeasures and suggestions to improve the new rural cooperative medical system in Jilin have become a top priority.
[purpose]
In this paper, through the comparative study of the data of the new rural cooperation years in Jilin and the whole country, the longitudinal comparison of the new agricultural cooperation data in Jilin Province in recent years, evaluation of the development status of the new agricultural cooperation in Jilin Province, the analysis of the existing problems in the development, and the experience of the rural medical security system in other countries and the development of the new agricultural cooperation in the typical areas of the country. Some useful countermeasures and suggestions are put forward for the development of Jilin new rural cooperative medical system.
[research methods]
In this study, the report of the new agricultural cooperation (nncms) in Jilin province was collected for 2007~2012 years, and the system policies were collected, and the 2007~2012 year "China Health Statistics Yearbook" and "the national economic and social development statistical bulletin of Jilin province" were reviewed. The situation of the health resources in Jilin Province, the development of the new agricultural cooperation, the operation of the fund and the construction of the agencies were reviewed and reviewed. Price, put forward the problems and Countermeasures in the operation of the new rural cooperative medical system.
[results]
1. the per capita health resources in Jilin province continued to increase from.2007 to 2012. The per capita health resources in Jilin province (each thousand people with medical institutions and health technicians) kept growing, and higher than the national average in the same period, but the distribution of urban and rural health resources was uneven.
2. since the development of NCMS in Jilin province has achieved remarkable results since its development from.2007 to 2012, the number of participants increased from 10 million 468 thousand to 13 million 282 thousand, the rate of participation increased from 82.1% to 99.4%, the total amount of financing increased from 536 million 565 thousand yuan to 3 billion 860 million yuan, and the per capita financing amount increased from 51.3 yuan to 290.6 yuan, but the per capita fund-raising was lower than the national average. The actual compensation ratio, the actual compensation ratio in the hospital and the compensation capping line significantly improved the actual compensation ratio and the actual hospitalization compensation ratio of 37% and 52.5% in.2012 years, respectively, increased by 15.3% and 23.5% in 2007, respectively, but lower than the national average in the same period; the compensation capping line was raised from 30 thousand yuan in 2007 to 80 thousand yuan in 2012, in some areas. Up to 100 thousand yuan.
3. the number of personnel management participation in the 3. county-level agencies is larger, and the gap between the regions is larger in.2011 years. The average number of personnel management participation in the county level agencies in Jilin province is 24112.1, the largest elm city is 140651, the smallest Jilin high tech Zone is 1263, and the difference between the two is 111.4 times.
4. the hospitalization expenses of the medical institutions at the county level above the county level were higher for.2012 years, and the average cost of hospitalization was 10009.1 yuan, and the cost of self-charge was 5686.2 yuan, which accounted for 66.1%. of the per capita net income of the year.
5. the proportion of hospitalized patients in county-level medical institutions and medical institutions above the county level is on the rise. The proportion of hospitalization in township level medical institutions is decreasing from.2007 to 2012. The proportion of inpatients in the county level medical institutions increased from 45.6% to 54.1%, and the medical institutions above the county level increased from 18.4% to 30.4%. The level of medical institutions dropped from 36% to 15.5%.
[Conclusion]
Since the new rural cooperative system of Jilin province has been carried out, its operation has been smooth and remarkable achievements have been achieved. However, there are also some problems. First, the financing standards are not scientific and the financing channels are single. Second, the lack of reasonable budget for the use of funds. Third, the overall development of out-patient services is slow. Fourth, county-level agencies are equipped with the number of staff. Unreasonable. Fifth, the inflow of hospitalization is unreasonable, and there is a trend of increasing year by year.
【学位授予单位】：吉林大学
【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】
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