新农合引入商业保险案例分析和应用研究
发布时间：2019-06-27 16:53
【摘要】：我国自2003年推行新型农村合作医疗制度以来,农民参合率逐年增加,筹资水平大幅提升,参合农民受益面不断扩大,保障水平显著提高,切实减轻了农民的就医负担,使农民在获得基本医疗卫生保障方面发挥了重要的作用。某市目前各区县新农合人均筹资额在全国居于先进行列,保障水平的大幅度提高使得参合农民的满意率稳定提高。 但是在新农合的发展中也存在着诸如医疗费用上涨、医疗行为不当等一些不容忽视的问题,为了解决这些问题,提高保险资金的使用效率以避免浪费,全国的许多地区尝试引入市场机制参与到医疗保险中来合作进行管理和经办。2002年开始,各地就已纷纷开展委托专业商业保险机构来参与经办农村合作医疗的做法,并且取得了较好的效果,农民参合率进一步上升,筹资和保障水平较之前都有大幅提高,减轻了农民群众的就医负担。 目前某市的新农合工作尚未在全区县范围内都开展引入商业保险的合作模式,仅有某区的新农合采用了这种合作模式。虽然该区开展这种合作模式的时间不是很长,但是此模式的引用对该区农民医疗费用支出的改善已初见成效。 本文主要通过对在某市某区进行新农合引入商业保险机构参与经办改革作为试点案例进行研究,将新农合引入商业保险机构参与管理经办前后的情况进行对比分析,通过理论分析与实效分析相结合的方法,论证引入商业保险后的新农合对农民医疗费用支出的改进的效果。结合从参保农民、政府卫生部门、商业保险机构等角度分析新农合引入商保模式的优势,探讨引入商保模式在全市范围内的可推广性。希望对全市在新农合工作中引入该模式提供一定参考价值。
[Abstract]:Since the implementation of the new rural cooperative medical system in 2003, the participation rate of farmers has increased year by year, the level of financing has been greatly improved, the benefits of participating farmers have been continuously expanded, the level of security has been significantly improved, the burden of seeking medical treatment has been effectively reduced, and farmers have played an important role in obtaining basic medical and health security. At present, the per capita fund raising amount of NCMS in a certain city is in the advanced ranks of the whole country, and the satisfaction rate of participating farmers is steadily improved with the great improvement of the guarantee level. However, in the development of NCMS, there are also some problems that can not be ignored, such as rising medical expenses and improper medical behavior. in order to solve these problems and improve the efficiency of the use of insurance funds in order to avoid waste, many parts of the country have tried to introduce market mechanisms to participate in the management and operation of medical insurance. Since 2002, Various localities have carried out the practice of entrusting professional commercial insurance institutions to participate in the operation of rural cooperative medical care, and have achieved good results. The participation rate of farmers has further increased, and the level of financing and security has been greatly improved, thus reducing the burden on the masses of farmers to seek medical treatment. At present, the new rural cooperative work in a city has not yet carried out the cooperation mode of introducing commercial insurance in the whole district and county, and only the new NCMS in a certain area has adopted this cooperative mode. Although the cooperation model has not been carried out for a long time, the introduction of this model has achieved initial results in the improvement of farmers' medical expenses in this area. In this paper, through the pilot case study of the introduction of commercial insurance institutions into the reform of commercial insurance institutions in a certain district of a city, this paper makes a comparative analysis of the situation before and after the introduction of new agricultural cooperation institutions into commercial insurance institutions, and demonstrates the effect of the introduction of commercial insurance institutions on the improvement of farmers' medical expenses through the combination of theoretical analysis and actual effect analysis. Based on the analysis of the advantages of the introduction of commercial insurance model from the angles of insured farmers, government health departments and commercial insurance institutions, this paper probes into the extensibility of introducing commercial insurance model in the whole city. It is hoped that it will provide certain reference value for the whole city to introduce this model into the new agricultural cooperative work.
【学位授予单位】：首都经济贸易大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;F842.684
本文编号：2506979
[Abstract]:Since the implementation of the new rural cooperative medical system in 2003, the participation rate of farmers has increased year by year, the level of financing has been greatly improved, the benefits of participating farmers have been continuously expanded, the level of security has been significantly improved, the burden of seeking medical treatment has been effectively reduced, and farmers have played an important role in obtaining basic medical and health security. At present, the per capita fund raising amount of NCMS in a certain city is in the advanced ranks of the whole country, and the satisfaction rate of participating farmers is steadily improved with the great improvement of the guarantee level. However, in the development of NCMS, there are also some problems that can not be ignored, such as rising medical expenses and improper medical behavior. in order to solve these problems and improve the efficiency of the use of insurance funds in order to avoid waste, many parts of the country have tried to introduce market mechanisms to participate in the management and operation of medical insurance. Since 2002, Various localities have carried out the practice of entrusting professional commercial insurance institutions to participate in the operation of rural cooperative medical care, and have achieved good results. The participation rate of farmers has further increased, and the level of financing and security has been greatly improved, thus reducing the burden on the masses of farmers to seek medical treatment. At present, the new rural cooperative work in a city has not yet carried out the cooperation mode of introducing commercial insurance in the whole district and county, and only the new NCMS in a certain area has adopted this cooperative mode. Although the cooperation model has not been carried out for a long time, the introduction of this model has achieved initial results in the improvement of farmers' medical expenses in this area. In this paper, through the pilot case study of the introduction of commercial insurance institutions into the reform of commercial insurance institutions in a certain district of a city, this paper makes a comparative analysis of the situation before and after the introduction of new agricultural cooperation institutions into commercial insurance institutions, and demonstrates the effect of the introduction of commercial insurance institutions on the improvement of farmers' medical expenses through the combination of theoretical analysis and actual effect analysis. Based on the analysis of the advantages of the introduction of commercial insurance model from the angles of insured farmers, government health departments and commercial insurance institutions, this paper probes into the extensibility of introducing commercial insurance model in the whole city. It is hoped that it will provide certain reference value for the whole city to introduce this model into the new agricultural cooperative work.
【学位授予单位】：首都经济贸易大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;F842.684
【引证文献】
相关期刊论文 前2条
1 吴海波;;健康险参与基本医疗保障经办管理服务模式比较研究[J];国外医学(卫生经济分册);2014年02期
2 侯珊芳;雷寒;;新形势下社会医疗保险和商业健康保险的合作模式探析[J];重庆医学;2015年28期
，本文编号：2506979
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