慈溪市新型农村合作医疗制度的现况研究

发布时间：2018-11-18 10:30

【摘要】：医疗保障事关每一位国民的健康和幸福,意义重大。为改变广大农民因各种历史原因造成的基本无医疗保障现状,我国建立了新型农村合作医疗(以下简称“新农合”)制度。该制度自2003年试点,2008年在全国范围内推广,到2010年末已基本覆盖全国各农村地区,在很大程度上减轻了农民的医疗负担。尽管,新农合制度取得了显著成效,但在实施过程中暴露出的一些深层次问题和难点,主要是医疗费用的控制和定点医疗机构的监管问题有待进一步解决。目的：通过对慈溪市新农合实施以来,历年基金收支、参合农民住院费用、补偿情况以及定点医疗机构监管情况的分析,探讨新农合当前面临的实施难点问题——医疗费用增长和定点医疗机构监管困境的相关因素,并结合经济学有关理论对其原因进行综合、全面的分析,在借鉴国外医疗保险经验的基础上,对完善新农合制度中规范医疗机构服务、加强监管及控制医疗费用不合理增长提出相应的对策建议。方法：采用定量和定性研究、实证和规范研究相结合的方法,对慈溪市2004年1月至2012年度12月新农合基金收支、各级医疗机构门诊和住院人次构成及医疗费用补偿情况进行分析,并对2012年度定点医疗机构审核和考核中发现的问题进行评价；结合经济学相关理论对新农合制度设计本身、医疗费用增长的影响因素和定点医疗机构监管困境进行剖析。结果：慈溪市实施新农合制度的8年内,基金运行总体不够平稳,出现超支、沉淀等情况；在门诊率和住院率逐年上升的同时,医疗费用也呈现出逐年上升的趋势,以住院费用的增长尤为明显；新农合统筹基金主要用于住院费用的补偿,占总补偿金额的73.89%；不同级别医疗机构的住院人次、住院基金的构成中,市级、市外医疗机构占70%以上,镇级医疗机构2012年分别下降至12.21%、8.13%,就医需求不合理,存在外流现象；在住院补偿逐年增加的情况下,参合农民的住院补偿收益因住院费用的日益上涨有所抵消；医疗机构级别越高,次均住院费用也越高；药品收入仍作为医疗机构的主要收入来源,2012年市级医疗机构住院费用构成中药费占42.37%；在提供医疗服务过程中定点医疗机构存在的多种不规范行为。结论： 1.慈溪市新农合制度为满足当地农民的医疗需求,减轻疾病的经济负担发挥了积极的作用； 2.住院费用的过快增长和药品收入的主导地位以及定点医疗机构的不规范行为,是新农合实施过程中的难点问题； 3.控制医疗费用的不合理增长,规范诊疗行为,加强定点医疗机构的监管,是新农合工作的关键环节； 4.建议强化政府责任、科学调整补偿方案、促使人才下沉、全面开展支付方式改革、创新监管模式、加快新农合立法、完善医疗服务定价机制、整合医疗卫生资源等措施完善新农合制度,保证可持续发展。
[Abstract]:Health care is of great significance to the health and happiness of every nation. In order to change the current situation of farmers' basic lack of medical security caused by various historical reasons, China has established a new rural cooperative medical system (hereinafter referred to as "New Rural Cooperation") system. The system was tested in 2003 and popularized in the whole country in 2008. By the end of 2010, it has basically covered the rural areas of the whole country, and greatly alleviated the medical burden of farmers. Although the new rural cooperative system has achieved remarkable results, some deep problems and difficulties, mainly the control of medical expenses and the supervision of designated medical institutions, have been exposed in the course of implementation. Objective: to analyze the income and expenditure of the fund, the hospitalization expenses of the participating farmers, the compensation situation and the supervision of the designated medical institutions since the implementation of the New Rural Cooperation in Cixi City. This paper probes into the difficult problems in the implementation of NCMS at present-the factors related to the growth of medical expenses and the dilemma of supervision of designated medical institutions, and combines the relevant theories of economics to make a comprehensive and comprehensive analysis of the causes. On the basis of drawing lessons from the experience of foreign medical insurance, this paper puts forward corresponding countermeasures and suggestions to perfect the medical institution service in the new rural cooperative system, to strengthen the supervision and control of the unreasonable increase of medical expenses. Methods: quantitative and qualitative studies, empirical and normative studies were used to study the income and expenditure of the New Agricultural Cooperation Fund from January 2004 to December 2012 in Cixi City. The composition of outpatient service and hospitalization and the compensation of medical expenses were analyzed, and the problems found in the audit and examination of designated medical institutions in 2012 were evaluated. Combined with the relevant economic theory, this paper analyzes the design of NCMS system itself, the influencing factors of medical expenditure growth and the dilemma of supervision of fixed medical institutions. Results: in the 8 years after the implementation of the new agricultural cooperation system in Cixi City, the fund operation was not stable enough, such as overspending, precipitation and so on. At the same time, the outpatient service rate and hospitalization rate are rising year by year, especially the increase of hospitalization expenses, the NCMS fund is mainly used to compensate the hospitalization expenses, which accounts for 73.89% of the total compensation amount. In the composition of hospitalization fund of different level medical institutions, the proportion of municipal and out-of-city medical institutions accounted for more than 70%. In 2012, township level medical institutions fell to 12.21 and 8.13 respectively, the demand for medical treatment was unreasonable, and there was outflow phenomenon. In the case of increasing hospital compensation year by year, the income of compensation for hospitalization of participating farmers is offset by the increasing of hospitalization expenses, and the higher the level of medical institutions, the higher the average hospitalization expenses. Drug revenue is still the main source of income for medical institutions. In 2012, 42.37% of the hospital expenses of municipal medical institutions were made up of drug expenses, and a variety of non-standard behaviors existed in designated medical institutions in the process of providing medical services. Conclusion: 1. Cixi new rural cooperative system has played a positive role in meeting the medical needs of local farmers and reducing the economic burden of disease; 2. The rapid increase of hospitalization expenses, the dominant position of drug income and the nonstandard behavior of designated medical institutions are the difficult problems in the implementation of NCMS. Controlling the unreasonable increase of medical expenses, standardizing the behavior of diagnosis and treatment, and strengthening the supervision of designated medical institutions are the key links of the new rural cooperative work. It is suggested to strengthen the responsibility of the government, adjust the compensation scheme scientifically, urge the talented person to sink, carry out the reform of the payment method in an all-round way, innovate the supervision mode, speed up the legislation of the new rural cooperation, and perfect the pricing mechanism of the medical service. Integration of medical and health resources and other measures to improve the new system of rural cooperation to ensure sustainable development.
【学位授予单位】：浙江大学
【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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