江西省新型农村合作医疗费用控制实证研究

发布时间：2018-12-08 16:51

【摘要】：江西省新型农村合作医疗制度从局部试点到全面实施已有10年。作为农村地区一项基本医疗保障制度，新型农村合作医疗制度通过建立疾病风险共担的保障机制，有效的提高了农民对于卫生服务的支付能力和抵抗疾病风险的能力，在一定程度上缓解了“因病致贫，因病返贫”问题。但是，近年来新型农村合作医疗费用出现快速增长，不仅给国家财政和参合农民带来了巨大的经济负担，而且制约了医疗保障水平的提高。控制医疗费用的过快增长，，使有限的资金发挥最大的社会效益和经济效益，对于有效解决农民“看病难，看病贵”问题，保持新型农村合作医疗制度的持续健康发展具有重要意义。基于此，本论文从新型农村合作医疗费用，尤其是次均住院费用为切入点，重点研究江西省新型农村合作医疗的费用控制问题，论文共分为六章。第一章是导论，说明论文的研究背景、文献综述、研究框架、研究内容和研究方法等。第二章论述了与医疗费用及费用控制相关的概念和基础理论，对影响新型农村合作医疗费用上涨的因素作出了理论分析。第三章是对江西省新型农村合作医疗费用控制现状的实证研究。通过对江西省新型农村合作医疗费用的数据分析，得出以下结论：江西省新型农村合作医疗制度总体运行良好；实际住院补偿比不断提高，但次均住院费用和次均住院补偿费用出现较快增长；在各级医疗机构中，县级以上定点医疗机构（尤其是省级医院）的次均住院费用最高，其次是县级医疗机构；参合病人和新农合基金越来越多流向县级医疗机构。对此，江西省推行了多项费用控制措施，包括推行医疗费用支付方式改革、加强定点医疗机构监管、强化次均住院费用控制、实施基本药物制度等。第四章是对泰和县新型农村合作医疗费用控制的案例分析。研究发现：泰和县新型农村合作医疗总体运行平稳，但次均住院费用上涨较快；在各级医疗机构中，县级医疗机构的次均住院费用增长最快；住院补偿基金主要流向县级医疗机构。为控制医疗费用，泰和县推行的措施主要有：严格控制乡镇定点医疗机构住院人次；控制参合病人住院用药费用；实行单病种限价管理；实行住院基金总量控制。第五章是对国内外医疗保险费用控制的经验借鉴，包括对德国、美国、英国、新加坡等国的经验借鉴，以及国内部分地区新型农村合作医疗费用控制的实践经验借鉴。第六章对加强新型农村合作医疗费用控制提出政策建议。一是改革和完善医疗费用支付方式，改变单一的按服务项目付费方式，实行以预付制为主的混合支付制度；二是制定和完善三级医疗机构的双向转诊制度，合理分流病人；三是建立完善的监督约束机制，严格规范医疗服务行为。
[Abstract]:Jiangxi Province new rural cooperative medical system from partial pilot to full implementation of 10 years. As a basic medical security system in rural areas, the new rural cooperative medical care system has effectively improved farmers' ability to pay for health services and resist disease risks by establishing a mechanism to guarantee the sharing of disease risks. To some extent, it alleviates the problem of "poverty caused by illness and returning to poverty because of illness". However, in recent years, the new rural cooperative medical fee has been increasing rapidly, which not only brings a huge economic burden to the national finance and participating farmers, but also restricts the improvement of medical security level. To control the excessive growth of medical expenses, so that limited funds can bring into full play the greatest social and economic benefits, and to effectively solve the problem of "difficult and expensive medical treatment" for farmers, It is of great significance to maintain the sustainable and healthy development of the new rural cooperative medical system. Based on this, this paper focuses on the cost control of the new rural cooperative medical system in Jiangxi Province from the point of view of the new rural cooperative medical expenses, especially the average hospitalization cost. The paper is divided into six chapters. The first chapter is an introduction, explaining the research background, literature review, research framework, research content and research methods. The second chapter discusses the concepts and basic theories related to medical expenses and cost control, and makes a theoretical analysis of the factors that affect the increase of new rural cooperative medical expenses. The third chapter is an empirical study on the cost control of the new rural cooperative medical system in Jiangxi Province. Based on the data analysis of the new rural cooperative medical system in Jiangxi Province, the following conclusions are drawn: the new rural cooperative medical care system in Jiangxi Province is running well on the whole; The actual hospitalization compensation ratio is increasing, but the average hospitalization cost and the average hospitalization compensation cost are increasing rapidly. Among the medical institutions at all levels, the average hospitalization expenses of designated medical institutions at or above the county level (especially provincial hospitals) are the highest, followed by the county-level medical institutions, and more participating patients and new rural cooperative funds flow to county-level medical institutions. In view of this, Jiangxi Province has carried out a number of cost control measures, including the reform of the way of paying medical expenses, the strengthening of supervision of designated medical institutions, the strengthening of the control of sub-average hospitalization expenses, and the implementation of the system of essential drugs, and so on. The fourth chapter is a case study on the cost control of the new rural cooperative medical system in Taihe County. The study found that the overall operation of the new rural cooperative medical system in Taihe County was stable, but the average hospitalization cost increased rapidly, among the medical institutions at all levels, the average hospitalization cost of the county-level medical institutions increased fastest. Hospital compensation funds mainly flow to county-level medical institutions. In order to control the medical expenses, the measures carried out in Taihe County mainly include: strictly controlling the number of in-patients in designated medical institutions in villages and towns; controlling the hospitalization expenses of participating patients; implementing the price limit management of single disease; and carrying out the total amount control of hospital funds. The fifth chapter is the experience of medical insurance cost control at home and abroad, including Germany, the United States, the United Kingdom, Singapore and other countries, as well as some areas of the new rural cooperative medical expenses control practical experience. Chapter six puts forward policy recommendations to strengthen the cost control of new rural cooperative medical system. The first is to reform and perfect the payment method of medical expenses, to change the single payment method according to service items, to implement the mixed payment system based on prepayment system, to formulate and perfect the two-way referral system of three-level medical institutions, and to distribute patients rationally. Third, establish perfect supervision and restraint mechanism, strictly standardize medical service behavior.
【学位授予单位】：江西财经大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;F842.684;R197.1

【参考文献】