长春市新型农村合作医疗住院患者受益情况现状分析及对策研究
发布时间：2018-08-18 14:59
【摘要】：我国新型农村合作医疗（以下简称“新农合”）制度是由政府支持、农民群众与农村经济组织共同筹资、在医疗上实行互助互济的一种有医疗保险性质的农村健康保障制度。据有关研究资料表明，由于医疗费用持续上涨，使得参合农民在获得医疗费用补偿后的负担不降反升，这不仅影响农民参合的积极性，而且影响新农合的运行质量和效果。因此，该项制度能否从真正意义上使参合农民的个人自费负担得到改观，从而切实提高参合农民的受益水平，是全面建设社会主义新农村的关键。 【目的】本研究以新农合制度下，长春地区住院参合患者的受益情况为切入点，对2013年长春地区参合患者住院医药费用与补偿情况进行全方位实证分析，客观评价新农合制度运行以来取得的成效，深入剖析影响参合农民受益水平的主要原因及其存在的问题，有针对性地提出进一步提高参合农民受益水平的政策建议，对于进一步巩固新农合制度的发展具有深远的现实意义。 【方法】采用文献研究和实证调查相结合的方式，对长春地区参合患者住院医药费用分流及补偿情况、个人自费医药费金额、次均自付住院医药费用占医药费总额及个人年度收入比例情况等方面进行综合分析。资料来源为吉林省新农合统计信息系统中的2013年长春地区新农合报表数据。采用SPSS13.0统计软件进行数据录入与分析，统计学方法为描述性分析。 【结果】 2013年，长春市共有农业人口3971290人，参合人数为3774615人，，常住人口参合率为99.7％。参合人口中住院患者为330137人次，受益率为8.7％。住院总费用为219590万元，次均住院费用为6652元，补偿总金额为109263万元，次均补偿费用为3310元，补偿比为49.76％。 2013年，长春地区参合人员中，在乡（镇）级定点医疗机构就诊的住院患者为45893人次，住院总费用为11031万元，补偿总金额为8008万元，补偿比为72.59％。在县（区）级定点医疗机构就诊的住院患者为171462人次，住院总费用为72337万元，补偿总金额为44308万元，补偿比为61.25％。在县级以上定点医疗机构就诊的住院患者为112782人次，住院总费用为190997万元，补偿总金额为77223万元，补偿比为40.61％。 2013年，乡（镇）级新农合定点医疗机构住院医药费政策补偿比为85％，实际补偿比例为72.59％；县（区）级新农合定点医疗机构住院医药费政策补偿比为75％，实际补偿比例为61.25％；县级以上（即省、市级）新农合定点医疗机构住院医药费政策补偿比为55％。实际补偿比例为40.61％。 2013年，长春市参合住院患者为330137人次，自付住院医药费总金额为110325万，人均自付住院医药费金额为3342元。其中，九台市参合住院患者个人自付医药费占年均个人收入的比例为25.83％；榆树市参合住院患者个人自付医药费占年均个人收入的比例为16.55％；农安县参合住院患者个人自付医药费占年均个人收入的比例为28.31％；德惠市参合住院患者个人自付医药费占年均个人收入的比例为28.14％；双阳区参合住院患者个人自付医药费占年均个人收入的比例为21.93％。 【结论】 （1）新型农村合作医疗制度的实施，有效减轻了长春市参合住院患者的疾病负担，因病致贫、因病返贫问题得到了缓解。 （2）长春市参合农民的住院人次、住院费用和住院补偿费用分流到县级以上和县级医疗机构的比例大，分流到乡级医疗机构的比例小。定点医疗机构的级别越高，住院补偿比越低，乡级医疗机构的住院补偿比最高。 （3）住院患者医药费用实际补偿比例低于新农合补偿制度政策补偿比例，个人自付医药费经济负担较重，新农合住院患者的受益水平仍有待提高。
[Abstract]:The New Rural Cooperative Medical System (NCMS) in China is a kind of rural health insurance system with the nature of medical insurance supported by the government and financed by the peasants and rural economic organizations. The burden of the participating peasants will rise instead of decrease, which will not only affect the enthusiasm of the peasants to participate in the new rural cooperative medical system, but also affect the quality and effect of the operation of the new rural cooperative medical system. The key to the new countryside.
[Objective] Based on the benefit of inpatients in Changchun under the New Agricultural Cooperative Medical System, this study made an all-round empirical analysis on the medical expenses and compensation of inpatients in Changchun in 2013, objectively evaluated the achievements of the new rural cooperative medical system since its operation, and deeply analyzed the main factors influencing the level of farmers'benefit. It is of far-reaching practical significance to further consolidate the development of the new rural cooperative medical system by putting forward policy suggestions to further improve the benefit level of participating farmers.
[Methods] By means of literature study and empirical investigation, the distribution and compensation of hospitalization medical expenses, the amount of individual medical expenses, the proportion of each individual medical expenses to the total medical expenses and the annual income of individuals in Changchun were analyzed. The report data of the New Rural Cooperative Medical Scheme in Changchun in 2013 were input and analyzed by SPSS13.0 statistical software. The statistical method was descriptive analysis.
[results]
In 2013, there were 397,129 agricultural people in Changchun, 377,4615 participants, 99.7% of them were permanent residents. The total hospitalization expenses were 21.59 million yuan, the average hospitalization expenses were 6652 yuan, the total compensation amount was 10.92 million yuan, the average compensation cost was 331 yuan, the compensation ratio was 4.7%. 9.76%.
In 2013, among the participants in Changchun, 45,893 inpatients were hospitalized in designated medical institutions at Township (town) level, the total cost of hospitalization was 11.31 million yuan, the total amount of compensation was 8.08 million yuan, and the compensation ratio was 72.59%. In designated medical institutions at County (district) level, 171,462 inpatients were hospitalized, and the total cost of hospitalization was 7,237 million yuan. The total cost of hospitalization was 19.997 million yuan, and the total compensation was 77.22 million yuan. The compensation ratio was 40.61%.
In 2013, the policy compensation ratio of hospitalization medical fees for rural (town) NCMS fixed-point medical institutions was 85%, and the actual compensation ratio was 72.59%; the policy compensation ratio of rural (district) NCMS fixed-point medical institutions was 75%, and the actual compensation ratio was 61.25%; and the hospitalization medical fees administration of NCMS fixed-point medical institutions at County (province, city) level was higher than that at County level. The compensation ratio is 55%., and the actual compensation ratio is 40.61%..
In 2013, there were 33137 hospitalized patients in Changchun, with a total amount of 11.325 million medical expenses paid by themselves and an average amount of 3,342 yuan per capita. The proportion of personal income was 16.55%; the proportion of personal medical fees paid by inpatients in Nong'an County was 28.31%; the proportion of personal medical fees paid by inpatients in Dehui City was 28.14%; the proportion of personal medical fees paid by inpatients in Shuangyang District was 21%. .93%.
[Conclusion]
(1) The implementation of the new rural cooperative medical system has effectively alleviated the disease burden of the inpatients in Changchun. The problem of returning to poverty due to illness has been alleviated.
(2) The proportion of hospitalization fees and compensation fees diverted to county-level and above-county-level medical institutions is larger than that to township-level medical institutions in Changchun.
(3) The actual compensation ratio of inpatients'medical expenses is lower than the policy compensation ratio of the new rural cooperative medical compensation system, and the economic burden of personal medical expenses is heavy. The benefit level of inpatients in the new rural cooperative medical system needs to be improved.
【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;F842.684;F323.89
本文编号：2189829
[Abstract]:The New Rural Cooperative Medical System (NCMS) in China is a kind of rural health insurance system with the nature of medical insurance supported by the government and financed by the peasants and rural economic organizations. The burden of the participating peasants will rise instead of decrease, which will not only affect the enthusiasm of the peasants to participate in the new rural cooperative medical system, but also affect the quality and effect of the operation of the new rural cooperative medical system. The key to the new countryside.
[Objective] Based on the benefit of inpatients in Changchun under the New Agricultural Cooperative Medical System, this study made an all-round empirical analysis on the medical expenses and compensation of inpatients in Changchun in 2013, objectively evaluated the achievements of the new rural cooperative medical system since its operation, and deeply analyzed the main factors influencing the level of farmers'benefit. It is of far-reaching practical significance to further consolidate the development of the new rural cooperative medical system by putting forward policy suggestions to further improve the benefit level of participating farmers.
[Methods] By means of literature study and empirical investigation, the distribution and compensation of hospitalization medical expenses, the amount of individual medical expenses, the proportion of each individual medical expenses to the total medical expenses and the annual income of individuals in Changchun were analyzed. The report data of the New Rural Cooperative Medical Scheme in Changchun in 2013 were input and analyzed by SPSS13.0 statistical software. The statistical method was descriptive analysis.
[results]
In 2013, there were 397,129 agricultural people in Changchun, 377,4615 participants, 99.7% of them were permanent residents. The total hospitalization expenses were 21.59 million yuan, the average hospitalization expenses were 6652 yuan, the total compensation amount was 10.92 million yuan, the average compensation cost was 331 yuan, the compensation ratio was 4.7%. 9.76%.
In 2013, among the participants in Changchun, 45,893 inpatients were hospitalized in designated medical institutions at Township (town) level, the total cost of hospitalization was 11.31 million yuan, the total amount of compensation was 8.08 million yuan, and the compensation ratio was 72.59%. In designated medical institutions at County (district) level, 171,462 inpatients were hospitalized, and the total cost of hospitalization was 7,237 million yuan. The total cost of hospitalization was 19.997 million yuan, and the total compensation was 77.22 million yuan. The compensation ratio was 40.61%.
In 2013, the policy compensation ratio of hospitalization medical fees for rural (town) NCMS fixed-point medical institutions was 85%, and the actual compensation ratio was 72.59%; the policy compensation ratio of rural (district) NCMS fixed-point medical institutions was 75%, and the actual compensation ratio was 61.25%; and the hospitalization medical fees administration of NCMS fixed-point medical institutions at County (province, city) level was higher than that at County level. The compensation ratio is 55%., and the actual compensation ratio is 40.61%..
In 2013, there were 33137 hospitalized patients in Changchun, with a total amount of 11.325 million medical expenses paid by themselves and an average amount of 3,342 yuan per capita. The proportion of personal income was 16.55%; the proportion of personal medical fees paid by inpatients in Nong'an County was 28.31%; the proportion of personal medical fees paid by inpatients in Dehui City was 28.14%; the proportion of personal medical fees paid by inpatients in Shuangyang District was 21%. .93%.
[Conclusion]
(1) The implementation of the new rural cooperative medical system has effectively alleviated the disease burden of the inpatients in Changchun. The problem of returning to poverty due to illness has been alleviated.
(2) The proportion of hospitalization fees and compensation fees diverted to county-level and above-county-level medical institutions is larger than that to township-level medical institutions in Changchun.
(3) The actual compensation ratio of inpatients'medical expenses is lower than the policy compensation ratio of the new rural cooperative medical compensation system, and the economic burden of personal medical expenses is heavy. The benefit level of inpatients in the new rural cooperative medical system needs to be improved.
【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;F842.684;F323.89
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