我国新型农村合作医疗制度的机理研究

发布时间：2018-08-30 17:24

【摘要】：本文首先对新农合制度进行详细的介绍，包括新农合制度产生的背景、新农合的演变过程，以及通过对比研究，探讨新型农村合作医疗制度与传统农村合作医疗的不同点，突出新农合制度的好处和优势，同时还分析新农合制度自启动以来每年的发展情况，分析新农合在发展过程中存在的问题，为下文研究该制度的机理提供现实参考依据。接着，本文研究新农合制度中政府补贴合同优化设计，通过构造政府、新农合基金管理机构、农民这三大主体的委托代理模型，利用数学方法，得到新农村合作医疗保险制度中最优的参合费用、最优政府补贴金额以及农民患病后所获报销比例的理论最优值。探讨在政府财政预算之内，在保障新农村合作医疗保险制度持续发展的前提下，如何吸引更多的农民参合。本文通过分析得到在某些条件下，新农合基金管理机构会套取新农合基金，骗取政府的财政补贴，导致没有农民愿意参与新农合。在这种情况下，为了让农民信任并且真正从新农合制度中受益，政府必须采取一些措施来监管和规范新农合基金管理机构的行为。最后，本文研究新农合定点医疗机构的选择策略，探讨在两类医疗服务水平不同的医院中如何选择定点医疗机构能使得看病的参合患者达到最多。文章的最后通过数值试验说明：选择三甲医院作为定点医疗机构时，，看病的总人数比选择社区医院作为定点医疗机构时看病的总人数多，而且两种情况下看病总人数的差值随着报销比例的增大而增大。通过分析两种情况下政府的预算还得到，当参合患者对三甲医院医疗服务水平的感知价值非常接近对社区医院医疗服务水平的感知价值时，政府对定点医疗医院的选择存在一个最优策略。该策略是，选择医疗服务水平比较高的三甲医院作为定点医疗机构，能在保证看病人数最多的基础上，实现政府预算的最小化。
[Abstract]:This paper firstly introduces the new rural cooperative medical system in detail, including the background of the new rural cooperative medical system, the evolution process of the new rural cooperative medical system, and discusses the differences between the new rural cooperative medical system and the traditional rural cooperative medical system through comparative study. This paper highlights the advantages and advantages of the new agricultural cooperation system, analyzes the annual development of the new rural cooperation system since its inception, analyzes the problems existing in the development process of the new rural cooperation system, and provides a practical reference basis for the following study of the mechanism of the new agricultural cooperation system. Then, this paper studies the optimal design of the government subsidy contract in the new agricultural cooperation system. By constructing the principal-agent model of the government, the management agency of the new agricultural cooperative fund and the farmers, this paper uses the mathematical method. The theoretical optimal value of the optimal participation cost, the optimal government subsidy amount and the proportion of farmers' reimbursement after illness in the new rural cooperative medical insurance system are obtained. This paper discusses how to attract more farmers to participate in the cooperative medical insurance system under the premise of ensuring the sustainable development of the new rural cooperative medical insurance system within the government budget. In this paper, under some conditions, the new rural cooperative fund management agency will take the new rural cooperative fund, defrauding the government of financial subsidies, leading to no farmers willing to participate in the new rural cooperation. In this case, in order to make farmers trust and really benefit from the new rural cooperative system, the government must take some measures to supervise and regulate the behavior of the new rural cooperative fund management agency. Finally, this paper studies the selection strategy of NCMS designated medical institutions, and discusses how to select designated medical institutions in two kinds of hospitals with different levels of medical service. At the end of the paper, the numerical experiments show that the total number of doctors in the third Class A Hospital is more than that in the Community Hospital. And the difference between the total number of patients increased with the increase of reimbursement ratio. Through the analysis of the government budget in two cases, when the perceived value of the participating patients to the medical service level of the third Class A hospital is very close to the perceived value of the community hospital medical service level, The government has an optimal strategy for the selection of designated hospitals. The strategy is to select the third Class A Hospital which has a high level of medical service as a designated medical institution, which can minimize the government budget on the basis of ensuring the largest number of patients.
【学位授予单位】：华南理工大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;R197.1;F842.684

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