长春市朝阳区医疗保障城乡一体化现状研究

发布时间：2018-10-31 07:03

【摘要】：目的：在我国，不同类型的医疗保险在待遇和筹资方式等方面差异较大，并且城乡分割的局面人为地将参保患者划分为几个不同等级，阻碍了不同等级人群的流动，严重破坏了社会公平。因此医疗保险的城乡统筹工作对于巩固完善全民医保、实现可持续发展，具有更加重要、更加深远的现实意义。医疗保障是政府最大的民生工程。本研究旨在以长春市朝阳区为例，通过调查分析以及对城乡统筹试点长春市朝阳区三年运行的效果进行评价，从而提出科学完善的城乡一体化医疗保障对策建议，为政府进一步加大改革力度、缩小城乡差距、实施城乡统筹提供基本数据，也为相关职能部门的决策提供科学依据支持。方法：抽取长春市朝阳区某医院内，长春市城镇职工医保、城镇居民医保、新农合的高血压患者各100名，对比分析不同医保类型患者住院费用、住院天数，报销比例等情况，对不同医保类型患者住院医疗保险使用比较研究；对2011-2013年长春市朝阳区新农合患者在各级医疗机构就医的总人次，费用总额，医疗保险报销总额，个人现金总额情况，以新农合患者各级医疗机构就医情况进行比较研究。结果：（1）三种医保类型的参保者在住院就医时的住院总费用、住院天数、自费费用、自费比例、医保报销金额、报销比例等均存在显著差异性。城镇职工医保大部分指标高于其他两种类型。城镇居民医保患者和新农合参保者自费比例、报销比例情况相近。（2）自2011年起，长春市朝阳区的新农合患者在市级以上医院就诊人次、基金使用构成比逐年上升，而在区级及以下医院的就诊人次、基金使用构成比逐年减少；随着医疗机构级别的提高，新农合医保的患者在住院次均费用、住院次均自费费用方面升高；同一年份内，省级医疗机构的新农合医保患者的住院补偿比明显低于乡镇卫生院（社区卫生服务中心）。（3）长春市朝阳区医疗保险城乡统筹建设过程中，尚存在管理体制尚未统一、筹资方式和筹资标准分散，不同种类医疗保险差别较大、不同医疗保险所使用的目录不同、不同医疗保险管理体系的信息化程度存在差异等问题。结论：（1）城镇职工医保待遇高于其他两种类型。城镇居民医保患者和新农合参保者待遇相近，为城镇居民医保与新农合医保进行初步整合提供基础。（2）“看病难、看病贵”问题仍然存在，新农合患者的“舍近求远”显示出基层医疗机构建设的不完善。（3）长春市朝阳区医疗保险城乡统筹建设蓝图已初具规模，但是目前长春市朝阳区目前的城乡统筹情况与既有蓝图设立的目标之间仍有差距，以此为切入点，，提出针对性建议，以缩短差距，完善城乡统筹建设，促进长春市医疗保险一体化目标的早日实现。
[Abstract]:Objective: in China, different types of medical insurance have great differences in terms of treatment and financing, and the situation of urban and rural segmentation artificially divides the insured patients into several different grades, which hinders the flow of people of different classes. It seriously undermines social justice. Therefore, the urban and rural overall planning of medical insurance has more important and far-reaching practical significance for consolidating and perfecting universal medical insurance and realizing sustainable development. Health care is the government's largest livelihood project. The purpose of this study is to take Chaoyang District of Changchun City as an example, through investigation and analysis, as well as to evaluate the effect of three years' operation of Chaoyang District of Changchun City as a whole, so as to put forward scientific and perfect countermeasures and suggestions for medical security of urban and rural integration. It provides the basic data for the government to further strengthen the reform, reduce the gap between urban and rural areas, implement urban and rural planning, and also provide scientific support for the decision-making of relevant functional departments. Methods: a total of 100 patients with hypertension were collected from a hospital in Chaoyang District, Changchun City, including urban health insurance, medical insurance for urban residents and NCMS. The hospital expenses and hospitalization days of patients with different types of medical insurance were compared and analyzed. The proportion of reimbursement, the use of different types of medical insurance inpatient medical insurance use comparative study; A comparative study was made on the total number of visits, total expenses, total reimbursement of medical insurance, and total personal cash in the medical institutions of the new rural cooperative patients in Chaoyang District, Changchun City, from 2011 to 2013, according to the medical conditions of the new rural cooperative patients at all levels. Results: (1) there were significant differences in the total cost, the days of hospitalization, the self-expense, the proportion of self-expense, the amount of medical insurance reimbursement and the proportion of reimbursement in the three types of medical insurance. Most of the indexes of medical insurance for urban workers are higher than the other two types. The proportion of urban residents'medical insurance patients and the new rural cooperative insured is similar to the proportion of reimbursement. (2) since 2011, new rural cooperative patients in Chaoyang District, Changchun City, have visited hospitals at and above the municipal level. The proportion of fund use composition has increased year by year, while the ratio of fund use composition has decreased year by year in hospitals at district level and below. With the improvement of the level of medical institutions, the average cost of hospitalization and the cost of hospitalization were increased in the new rural cooperative medical insurance system. In the same year, the inpatient compensation ratio of NCMS patients in provincial medical institutions was significantly lower than that in township health centers (community health service centers). (3) in the process of urban and rural development of medical insurance in Chaoyang District, Changchun City, the management system has not yet been unified, the financing methods and standards are scattered, there are great differences between different kinds of medical insurance, and the catalogue used by different medical insurance is different. The informationization degree of different medical insurance management system is different and so on. Conclusion: (1) the treatment of medical insurance for urban workers is higher than the other two types. The treatment of urban residents' medical insurance patients and the new rural cooperative insurance providers is similar, which provides the basis for the initial integration of the urban residents' medical insurance and the new rural cooperative medical insurance. (2) the problem of "difficult to see a doctor and expensive to see a doctor" still exists. (3) the blueprint of urban and rural overall planning of medical insurance in Chaoyang District of Changchun City has begun to take shape, but there is still a gap between the present situation of urban and rural planning in Chaoyang District of Changchun City and the target set up by the existing blueprint, which is regarded as a breakthrough point. Some suggestions are put forward to shorten the gap, perfect the overall construction of urban and rural areas, and promote the realization of the goal of integration of medical insurance in Changchun as soon as possible.
【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

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