内蒙古新型农村合作医疗运行效果评价研究
发布时间：2019-02-12 17:30
【摘要】：如何科学合理地构建一套关于新型农村合作医疗运行效果评价的指标体系,从而客观科学地评价内蒙古自治区新型农村合作医疗的运行状况,以提高运行质量和效果,促进该制度健康稳定地发展,成为这项制度进入全面推广时期后面临的首要问题。由于不同地区之间在经济发展、农民收入、农民的卫生观念、政策干预和导向以及基础环境等诸多方面存在着差异,新型农村合作医疗制度在各地推行的模式、实施的方案也不一致,目前还没有一套统一的评价指标。另外,与传统的合作医疗制度相比,新型农村合作医疗制度在资金筹集、资金使用、费用补偿、监督管理、受益程度等方面有很多地方实现了突破与创新。 本文运用理论分析与实证分析相结合的方法,首先阐述了新型农村合作医疗制度的基本概念,叙述了我国新型农村合作医疗制度的历史沿革,介绍了新型农村合作医疗制度的相关理论,分析了新型农村合作医疗制度的运行模式。其后,对内蒙古自治区新型农村合作医疗制度的运行进行了总体评价,介绍了所取得的主要成效,并剖析了目前新型农村合作医疗制度存在的主要问题。在此基础上,根据运行效果评价的理论研究,运用变异系数法和聚类分析法,并适当结合专家咨询法,设计出一套新型农村合作医疗运行效果评价指标体系。最后,运用主成分分析法,对内蒙古自治区12个盟市的新型农村合作医疗的运行效果进行了综合评价,并根据评价结果提出了今后进一步完善新型农村合作医疗制度的建议。 本文形成的主要结论如下： 1.构建了内蒙古新型农村合作医疗运行效果评价指标体系。按照新型农村合作医疗的过程和结果,初步选取了26项指标,作为构成初选评价指标体系的评价指标,并计算了26项指标的数值,然后从基金筹集、基金使用、参合情况、费用负担、卫生资源利用以及受益程度6个方面进行了分组,形成了初选指标构成的评价体系。为了降低评价指标之间的相关度,提高评价指标的代表性,利用变异系数法和聚类分析法,并适当结合专家咨询法,对初步选定的26项指标进行了筛选,三种方法最终筛选出的指标为7项；这7项指标构成了对新型农村合作医疗运行效果进行综合评价的评价指标体系。 2.评价指标适合进行主成分分析。为了避免由于检验方法的单一照成检验结果的偏差,同时选取了KMO和巴特利特两种方法进行检验。通过检验,KMO=0.635(大于0.6),给出的相伴概率值为0.00,小于显著性水平0.05(有人认为是0.01),两种检验方法都说明适宜进行主成分分析。 3.内蒙古自治区新型农村合作医疗的发展是不均衡的。以往的学术研究多数在分析全国的新型农村合作医疗,或重在分析某省(市)试点县的新型农村合作医疗,而专门分析自治区新型农村合作医疗运行效果的研究目前还很少。我在这方面作了尝试,分析了内蒙古自治区新型农村合作医疗进入全面推广时期以后,12个盟市该制度运行的效果。结果显示,内蒙古自治区新型农村合作医疗的发展是不均衡的。 4.经济增长是影响新型农村合作医疗运行效果的重要因素。社会医疗保障的发展水平归根结底是由一个国家或地区的经济发展水平决定的,经济发展为医疗保障提供了前提和基础。只有经济发展了,才能提供医疗保障所需的物质基础,经济发展水平还决定了医疗保障的广度和深度。比如,鄂尔多斯市运行效果的排名占居首位,排序情况也是与该市近几年经济的高速增长相吻合的。 5.在推进新型农村合作医疗运行的过程中,政府承担着主要责任,发挥着主导作用。在新型农村合作医疗的发展定位、基金筹集与分配使用、正确处理农村与城市医疗卫生资源配置的矛盾等方面,都需要政府的组织、参与、协调、控制。
[Abstract]:How to scientifically and reasonably construct a set of index system on the evaluation of the operation effect of the new rural cooperative medical system, so as to objectively and scientifically evaluate the operating conditions of the new rural cooperative medical service in the Inner Mongolia Autonomous Region, so as to improve the operation quality and the effect, and to promote the healthy and stable development of the system, It is the first problem that the system faces after the full-scale promotion period. Due to the differences in the economic development, the farmer's income, the farmer's health concept, the policy intervention and the guidance and the basic environment among different regions, the new rural cooperative medical service system is implemented in various places, and the scheme of the implementation is not consistent, There is no uniform set of evaluation indicators at this time. In addition, compared with the traditional cooperative medical system, the new rural cooperative medical care system has many places to realize the breakthrough and innovation in the aspects of fund raising, fund use, cost compensation, supervision and administration, benefit degree and so on. In this paper, the basic concept of the new rural cooperative medical service system is described, the history of the new rural cooperative medical service system is described, and the related principles of the new rural cooperative medical system are introduced. On the Operation Model of the New Rural Cooperative Medical System After that, the overall evaluation of the operation of the new rural cooperative medical system in the Inner Mongolia Autonomous Region has been carried out, the main results have been introduced, and the main question of the existence of the new rural cooperative medical service system is also analyzed. On this basis, according to the theoretical study of the evaluation of the running effect, the coefficient of variation method and the cluster analysis method are used to design a new evaluation index for the operation effect of the new rural cooperative medical service based on the expert consultation method. In the end, the main component analysis method is used to comprehensively evaluate the operation effect of the new rural cooperative medical service in the 12 Union cities of Inner Mongolia Autonomous Region, and the construction of the new rural cooperative medical system will be further improved in the future based on the evaluation results. The main knots formed in this paper The discussion is as follows: 1. The evaluation of the operation effect of the new rural cooperative medical service in Inner Mongolia is constructed. According to the process and result of the new rural cooperative medical system, 26 indexes were selected, which were used as the evaluation index of the index system of primary selection, and the numerical value of 26 indexes was calculated. The primary index composition is formed by grouping the cost burden, the utilization of the health resources and the benefit degree. In order to reduce the degree of correlation between the evaluation indexes, the representativeness of the evaluation index is improved, the coefficient of variation method and the cluster analysis method are used, and the expert consultation method is used to filter the 26 indexes which are preliminarily selected, and the three methods are finally screened out. The index is 7; the seven indicators form a comprehensive evaluation of the operation effect of the new rural cooperative medical system price index system. 2. The evaluation index is suitable The main component analysis is carried out. In order to avoid the deviation of the inspection result due to the single result of the inspection method, the KMO and Bartlett are selected. The test results show that KMO = 0. 635 (more than 0.6), the associated probability value is 0. 00, which is less than the significance level of 0.05 (it is considered to be 0.01), and the two test methods are appropriate. Main component analysis. 3. New rural cooperative medicine in Inner Mongolia Autonomous Region The development of the treatment is not balanced. The past academic research is mostly in the analysis of the new rural cooperative medical system in the whole country, or the new type of new rural cooperative medical service in a province (city) is analyzed, and the operation efficiency of the new rural cooperative medical system in the autonomous region is analyzed. The research of the fruit is very low. I made an attempt in this respect, and analyzed the total extension period of the new rural cooperative medical system in Inner Mongolia Autonomous Region. The results show that the new rural cooperative medicine in Inner Mongolia Autonomous Region The development of therapy is not balanced. 4. Economic growth is the influence of the new rural cooperation The level of the development of social medical security is determined by the level of economic development in a country or region, and the economic development is a medicine The premise and foundation of the medical insurance is provided. Only the development of the economy can provide the material basis for medical security, and the level of economic development is also decided The breadth and depth of medical security are the first place in the city's running effect, and the ranking is the same as the city in recent years. In the process of advancing the operation of the new rural cooperative medical system, the government is responsible for the high-speed growth of the economy. The main responsibility is to play a leading role in the development and positioning of the new rural cooperative medical system, the use of fund raising and distribution, the proper handling of the contradiction between the rural and urban health resources allocation, etc.
【学位授予单位】：内蒙古农业大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R197.1;F323.89;F842.684
本文编号：2420630
[Abstract]:How to scientifically and reasonably construct a set of index system on the evaluation of the operation effect of the new rural cooperative medical system, so as to objectively and scientifically evaluate the operating conditions of the new rural cooperative medical service in the Inner Mongolia Autonomous Region, so as to improve the operation quality and the effect, and to promote the healthy and stable development of the system, It is the first problem that the system faces after the full-scale promotion period. Due to the differences in the economic development, the farmer's income, the farmer's health concept, the policy intervention and the guidance and the basic environment among different regions, the new rural cooperative medical service system is implemented in various places, and the scheme of the implementation is not consistent, There is no uniform set of evaluation indicators at this time. In addition, compared with the traditional cooperative medical system, the new rural cooperative medical care system has many places to realize the breakthrough and innovation in the aspects of fund raising, fund use, cost compensation, supervision and administration, benefit degree and so on. In this paper, the basic concept of the new rural cooperative medical service system is described, the history of the new rural cooperative medical service system is described, and the related principles of the new rural cooperative medical system are introduced. On the Operation Model of the New Rural Cooperative Medical System After that, the overall evaluation of the operation of the new rural cooperative medical system in the Inner Mongolia Autonomous Region has been carried out, the main results have been introduced, and the main question of the existence of the new rural cooperative medical service system is also analyzed. On this basis, according to the theoretical study of the evaluation of the running effect, the coefficient of variation method and the cluster analysis method are used to design a new evaluation index for the operation effect of the new rural cooperative medical service based on the expert consultation method. In the end, the main component analysis method is used to comprehensively evaluate the operation effect of the new rural cooperative medical service in the 12 Union cities of Inner Mongolia Autonomous Region, and the construction of the new rural cooperative medical system will be further improved in the future based on the evaluation results. The main knots formed in this paper The discussion is as follows: 1. The evaluation of the operation effect of the new rural cooperative medical service in Inner Mongolia is constructed. According to the process and result of the new rural cooperative medical system, 26 indexes were selected, which were used as the evaluation index of the index system of primary selection, and the numerical value of 26 indexes was calculated. The primary index composition is formed by grouping the cost burden, the utilization of the health resources and the benefit degree. In order to reduce the degree of correlation between the evaluation indexes, the representativeness of the evaluation index is improved, the coefficient of variation method and the cluster analysis method are used, and the expert consultation method is used to filter the 26 indexes which are preliminarily selected, and the three methods are finally screened out. The index is 7; the seven indicators form a comprehensive evaluation of the operation effect of the new rural cooperative medical system price index system. 2. The evaluation index is suitable The main component analysis is carried out. In order to avoid the deviation of the inspection result due to the single result of the inspection method, the KMO and Bartlett are selected. The test results show that KMO = 0. 635 (more than 0.6), the associated probability value is 0. 00, which is less than the significance level of 0.05 (it is considered to be 0.01), and the two test methods are appropriate. Main component analysis. 3. New rural cooperative medicine in Inner Mongolia Autonomous Region The development of the treatment is not balanced. The past academic research is mostly in the analysis of the new rural cooperative medical system in the whole country, or the new type of new rural cooperative medical service in a province (city) is analyzed, and the operation efficiency of the new rural cooperative medical system in the autonomous region is analyzed. The research of the fruit is very low. I made an attempt in this respect, and analyzed the total extension period of the new rural cooperative medical system in Inner Mongolia Autonomous Region. The results show that the new rural cooperative medicine in Inner Mongolia Autonomous Region The development of therapy is not balanced. 4. Economic growth is the influence of the new rural cooperation The level of the development of social medical security is determined by the level of economic development in a country or region, and the economic development is a medicine The premise and foundation of the medical insurance is provided. Only the development of the economy can provide the material basis for medical security, and the level of economic development is also decided The breadth and depth of medical security are the first place in the city's running effect, and the ranking is the same as the city in recent years. In the process of advancing the operation of the new rural cooperative medical system, the government is responsible for the high-speed growth of the economy. The main responsibility is to play a leading role in the development and positioning of the new rural cooperative medical system, the use of fund raising and distribution, the proper handling of the contradiction between the rural and urban health resources allocation, etc.
【学位授予单位】：内蒙古农业大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R197.1;F323.89;F842.684
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