青岛市新型农村合作医疗基金运行的问题与对策研究

发布时间：2019-04-13 10:42

【摘要】：新型农村合作医疗直接关系到我国几亿农民的健康和利益,是医疗体制改革的重要组成部分,是中央为解决“三农”问题而做出的重大决策,对于落实科学发展观,促进城乡协调发展,建设小康社会,具有十分重要的意义。基金的运行安全是合作医疗制度运行的基础,如果合作医疗基金的运行安全得不到保障,必然会影响合作医疗制度的实施,影响党和政府在人民群众心目中的形象。如何确保合作医疗基金筹集管理使用的安全、建立合作医疗基金安全运行机制是一项关系国家稳定、社会和谐的大事。该文主要从现行的新农合基金筹集使用管理的现状入手,采用理论与实证相结合、定性定量分析法,制度分析法,通过对青岛市新农合实施现状的了解以及对相关数据进行分析与对比,找出青岛市新农合在基金运行过程中存在的问题并对其进行分析,并针对这些问题提出完善青岛新农合基金运行的对策。文章首先对国内外农村医疗研究现状和成果进行梳理、分析影响我国新农合健康持续发展的因素,以及新农合基金有效运行管理的重要意义和研究背景；然后对我国的新农合医疗的发展状况进行介绍,对我国新农合医疗基金的理论和运行机理做出归纳,包括基金的筹集的标准、筹集的方式、使用政策、管理措施等。然后通过结合青岛市新农合的发展和特点,对青岛市新农合现行状况的实证分析,通过对新农合基金的筹集、基金的管理、基金的使用三个方面的理论研究和实际调查,运用计算机审计、数据分析、多维分析等技术方法,找出青岛市新农合基金在运行实施的过程中存在的问题,其中重点介绍了审查基金筹集中参合人数不真造成虚假套取上级资金情况,基金管理中个人骗取新农合和集体套取新农合资金的情况；并通过对这些新农合基金筹集管理的问题分析,从政策制度层面指出管理的问题成因。最后针对目前新农合存在的问题提出新型农村合作医疗基金筹集管理、提高使用效益的对策,主要从组织领导、基金筹集保障、基金运行监督、优化补偿机制和健全法律法规等几个层面提出科学的针对性建议,建立符合青岛本地特色的合作医疗资金安全运行机制,促进制度的可持续发展和本地区新农村建设,以维护农民切身利益。
[Abstract]:The new rural cooperative medical system is directly related to the health and interests of hundreds of millions of peasants in our country, is an important part of the reform of the medical system, is an important decision made by the central government to solve the "three rural" problems, and is of great importance to the implementation of the scientific concept of development. It is of great significance to promote the coordinated development of urban and rural areas and build a well-off society. The operation security of the fund is the foundation of the operation of the cooperative medical system. If the operation security of the cooperative medical fund is not guaranteed, it will inevitably affect the implementation of the cooperative medical system and the image of the Party and the government in the eyes of the people. How to ensure the safety of the cooperative medical fund and how to establish the safe operation mechanism of the cooperative medical fund is an important matter related to the stability of the country and the harmony of the society. This article mainly starts with the present situation of the fund raising and using management, adopts the combination of theory and demonstration, qualitative and quantitative analysis, institutional analysis, and so on. Through the understanding of the current situation of the implementation of the new agricultural cooperation in Qingdao and the analysis and comparison of the relevant data, this paper finds out the problems existing in the operation of the fund and analyzes the problems in the fund operation of the new agricultural cooperation in Qingdao. And to solve these problems, the countermeasures to improve the operation of Qingdao New Agricultural Cooperation Fund are put forward. Firstly, the paper combs the current situation and achievements of rural medical research at home and abroad, analyzes the factors affecting the healthy and sustainable development of NCMS in China, as well as the important significance and research background of the effective operation and management of NCMS; Then it introduces the development of NCMS in our country, summarizes the theory and operation mechanism of NCMS fund in China, including the standard of fund raising, the way of raising fund, the policy of using, the management measure and so on. Then by combining the development and characteristics of the new agricultural cooperation in Qingdao, this paper makes an empirical analysis of the current situation of the new agricultural cooperation in Qingdao, through the theoretical research and practical investigation in three aspects: the raising of the new agricultural cooperation fund, the management of the fund, and the use of the fund. By means of computer audit, data analysis, multi-dimensional analysis and other technical methods, this paper finds out the problems existing in the operation and implementation of the New Agricultural Cooperation Fund in Qingdao. It focuses on the fact that the number of participants in the fund-raising is not really causing the false acquisition of higher-level funds, the individual in the management of the fund defrauded the new agricultural cooperation and collective acquisition of the new agricultural cooperation funds; And through the analysis of these new rural cooperative fund raising management problems, the paper points out the causes of the management problems from the policy system level. Finally, aiming at the problems existing in the new rural cooperative medical system, this paper puts forward the countermeasures of raising and managing the new rural cooperative medical fund and improving the efficiency of use, mainly from the organizational leadership, the guarantee of fund raising, the supervision of fund operation, and so on. In order to promote the sustainable development of the system and the construction of new rural areas in the region, scientific and targeted suggestions have been made on optimizing the compensation mechanism and perfecting laws and regulations, establishing a safe operation mechanism of cooperative medical funds in line with the local characteristics of Qingdao, and promoting the sustainable development of the system. In order to safeguard the vital interests of farmers.
【学位授予单位】：中国海洋大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;F842.684

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