新型农村合作医疗基金支付及其监管研究

发布时间：2019-01-06 14:30

【摘要】：在人们生活水平不断提高的大背景下,人们的卫生服务需求和卫生费用支出呈现逐年上涨的趋势,与之相应,医疗保险基金支付压力越来越大。因此如何选择医疗保险支付方式和在控制卫生费用的同时激励卫生服务机构提高服务质量,成为现阶段研究的主要问题。而支付方式改革涉及多方利益,良好的支付方式设计有利于控制医疗费用的不合理增长,节约医疗资源,提高新型农村合作医疗基金使用效率,提高参合农民的受益水平。本文借鉴我国医疗保险住院支付方式改革的主要经验与做法,对比不同支付方式的优势和弊端,并分析我国新农合支付方式改革现状,评价现有支付方式改革的成效,为进一步探索支付方式改革路径提供可靠依据,从而解决新农合运行过程中存在的医疗费用增长较快的问题。针对新农合的支付方式改革,本研究进一步从利益相关者的角度进行分析,包括对管理机构的监管、对定点医疗机构的监管和对参合农民的监管三大部分。以唐山市丰润区新农合支付中的监管为例,对新农合不同利益相关者的监管状况进行了分析,对相关监管方法进行探讨,目的是通过对支付中监管有关问题的研究,以期发展和创新新农合支付监管的方式方法,为新农合支付监管工作提供参考。
[Abstract]:Under the background of the continuous improvement of people's living standard, the demand for health services and the expenditure of health expenses are increasing year by year. Accordingly, the pressure of medical insurance fund to pay is increasing. Therefore, how to choose the payment method of medical insurance and how to encourage health service organizations to improve the service quality while controlling the health expenses become the main problems in the current research. The reform of payment mode involves various interests. A good design of payment mode is conducive to controlling the unreasonable growth of medical expenses, saving medical resources, improving the efficiency of using the new rural cooperative medical fund, and improving the benefit level of participating farmers. This article draws lessons from the main experience and practice of medical insurance inpatient payment reform in China, compares the advantages and disadvantages of different payment methods, analyzes the current situation of the reform of the new rural cooperative payment mode in China, and evaluates the effectiveness of the existing payment mode reform. It provides a reliable basis for further exploring the path of payment reform, thus solving the problem of rapid increase of medical expenses in the course of operation of NCMS. In view of the reform of payment mode of NCMS, this study further analyzes from the perspective of stakeholders, including the supervision of management agencies, the supervision of designated medical institutions and the supervision of participating farmers. Taking the supervision of the new rural cooperative payment in Fengrun District of Tangshan City as an example, this paper analyzes the supervision situation of the different stakeholders of the new rural cooperation, and probes into the relevant supervision methods, the purpose of which is to study the relevant problems in the supervision of the payment. In order to develop and innovate the new rural cooperative payment supervision methods and provide a reference for the new rural cooperative payment supervision.
【学位授予单位】：河北大学
【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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