乌鲁木齐市新农合重大疾病医疗保障运行现状研究

发布时间：2018-01-04 16:15

本文关键词：乌鲁木齐市新农合重大疾病医疗保障运行现状研究　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对乌鲁木齐市新农合重大疾病医疗保障的费用补偿情况、对因病致贫的改善情况以及住院费用影响因素进行分析,了解该项制度运行过程中的优点及存在的问题,为大病保险的实施提供经验与数据支持。方法:采用描述性统计方法对2012-2015年间乌鲁木齐市新农合重大疾病医疗保障补偿人次及费用变化进行梳理,比较分析补偿前后因病致贫改善情况,建立多重线性回归模型探索重大疾病患者住院费用影响因素,结合对新农合管理人员的访谈结果总结重大疾病医疗保障制度的优缺点并给出对策建议。结果:1.2012-2015年间乌鲁木齐市新农合重大疾病医疗保障补偿人次持续增长,从2012年199人次增长至2015年1154人次,患病人次最多的前三类重大疾病分别是终末期肾病、精神病及乳腺癌;2.重大疾病住院患者总费用、次均住院费用及实际补偿比均呈持续增长趋势,次均住院费用由2012年13502.95元增长至2015年15616.36元,实际补偿比由2012年的63.19%增长至2015年的66.53%;3.与新农合相比,新农合重大疾病医疗保障次均住院费用及实际补偿比均处于较高水平;4.药品费用占比重最高,均在48.86%以上,医疗费用所占比重则呈下降趋势,由2012年43.94%下降至2015年39.93%,药品费用2012-2015年结构变动率为49.96%,对总费用变动影响最大;5.新农合重大疾病医疗保障补偿后因病致贫发生情况明显减少,改善人次明显增加,从2012年110人次增长至2015年689人次,总体优于新农合对因病致贫改善情况;6.影响新农合重大疾病医疗保障患者住院费用因素包括性别、年龄、住院天数、医院等级、重复入院、药品费用、医疗费用、材料费用等。结论:新农合重大疾病医疗保障实际补偿比相对较高,病种选择较为典型,一定程度上缓解了因病致贫,但同时存在基金来源有限、保障覆盖面较窄、管理机制不完善等问题。建议推进城乡基本医保并轨,加快实施大病保险制度,规范临床路径,推行按病种付费制度,优化医务人员收入结构,深化药品制度改革,实施分级诊疗,强化慢性病健康管理。
[Abstract]:Objective: through the cost compensation of Urumqi new rural cooperative medical insurance for major diseases, improve the situation of poverty due to illness and hospitalization expense influencing factors were analyzed to understand the advantages and problems of the operation process of the legal system, to provide experience and data support for the implementation of serious illness insurance. Methods: descriptive statistical methods to sort out during the period of 2012-2015 in Urumqi new rural cooperative medical insurance for major diseases compensation for passengers and the cost change, comparative analysis before and after compensation poverty to improve the situation, the establishment of multiple linear regression model to explore the influencing factors of hospitalization expenses of patients with serious diseases, according to the results of the interview management personnel of major disease medical security system and the advantages and disadvantages of the countermeasures and suggestions are given. Results: during the period of 1.2012-2015 in Urumqi new rural cooperative medical insurance for major diseases compensation people continued to increase Long, from 2012 199 growth in 2015 to 1154 people, most of the time patients before three major diseases are end-stage renal disease, mental disease and breast cancer patients; the total cost of 2. major diseases, the average hospitalization expenses and the actual compensation ratio showed a sustained growth trend, the average hospitalization cost from 13502.95 yuan in 2012 in 2015 increased to 15616.36 yuan, the actual compensation ratio increased from 63.19% in 2012 to 66.53% in 2015 3.; and the new rural cooperative medical insurance for major diseases NCMS compared to the average hospitalization expenses and the actual compensation ratio are at a higher level; 4. drug costs accounted for the highest proportion, were more than 48.86%, the proportion of medical expenses decreased. From 2012 43.94% down to 39.93% in 2015, 2012-2015 drug expenditure structure change rate is 49.96%, changes in the greatest impact on the total cost; 5. occurred due to illness of major diseases NCMS medical insurance compensation The situation was significantly reduced, improving the people increased significantly, from 2012 110 growth in 2015 to 689 passengers, is better than that of NCMS improvement on poverty; 6. major diseases NCMS medical insurance inpatient cost factors including gender, age, duration of hospitalization, medical expenses, hospital grade, repeated admission, drug costs, material costs, etc.. Conclusion: the new rural cooperative medical insurance for major diseases the actual compensation ratio is relatively high, the selection of typical diseases, to some extent alleviate poverty due to illness, but there are limited sources of funds, guarantee the narrow coverage, management mechanism is not perfect. Suggestions to promote urban and rural basic medical insurance system, accelerate the implementation of serious illness insurance system, standardize the clinical path, according to the implementation of payment system, optimization of medical personnel income structure, deepen the reform of the system of medicine, implementation of grading treatment, strengthen the health management of chronic disease.

【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684;F323.89

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