新型农村合作医疗中道德风险研究

发布时间：2018-07-25 08:25

【摘要】：新型农村合作医疗制度自2003年实施以来,缓解了“看病难、看病贵”的问题,保障了农民的基本权益,适应了农村社会经济发展,同时又有利于提高我国医疗保障制度的公平性。但由于医疗市场的特殊性及新农合制度实施环境的复杂性,新型农村合作医疗在实施过程中遇到诸多问题,如不合理费用的增长、监管机制的不完善及新农合基金入不敷出等。这些问题既损害了新农合运行的效率,又影响了新农合制度的可持续发展。随着新农合制度的不断完善,政府补贴增加,道德风险随之而来。道德风险最早源于海上保险,近年来才逐渐运用各个领域。道德风险即是拥有信息较多的一方利用信息优势做出损害信息较弱一方的行为。在医疗市场中,由于医疗需求方、医疗提供方和医疗监督方之间掌握的信息不对称,再加上医疗体制的不合理及个人机会主义倾向等原因,道德风险问题愈演愈烈。道德风险的存在使医疗费用不合理增长,同时抑制了农民合理的卫生需求,损害了新型农村合作医疗的公平发展。本文以湖南省某县为例,通过个案访谈、参与观察法、文献分析法等途径,探求湖南省省级贫困县的新型农村合作医疗制度在运行过程中道德风险的表现及产生的内在机理。道德风险的表现主要从医疗需求方、医疗提供方和医疗监管方三个方面来论述,内在机理主要从医疗市场的特殊性、医疗体制的不合理及个人的机会主义倾向来阐述;其次通过利用2003-2013年中国卫生统计年鉴的数据进行高级统计分析,深入分析道德风险问题是否在全国范围内普遍存在,最后从宏观和微观层面论述如何规避道德风险,以期找寻有效解决道德风险的举措。
[Abstract]:Since the implementation of the new rural cooperative medical system in 2003, it has alleviated the problem of "difficult to see a doctor and expensive to see a doctor", guaranteed the basic rights and interests of farmers, and adapted to the social and economic development of rural areas. At the same time, it helps to improve the fairness of our medical security system. However, due to the particularity of the medical market and the complexity of the implementation environment of the new rural cooperative medical system, there are many problems encountered in the implementation of the new rural cooperative medical system, such as the increase of unreasonable expenses, the imperfection of the supervision mechanism and the income of the new rural cooperative fund. These problems not only impair the efficiency of NCMS operation, but also affect the sustainable development of NCMS system. With the continuous improvement of the new rural cooperation system, the government subsidy increases, moral hazard follows. Moral hazard originated from marine insurance and has been gradually used in various fields in recent years. Moral hazard is the behavior that the party with more information makes use of the advantage of information to harm the weaker party. In the medical market, due to the asymmetry of information between the medical demand side, the medical provider and the medical supervisor, coupled with the unreasonable medical system and the tendency of individual opportunism, the moral hazard becomes more and more serious. The existence of moral hazard makes the medical expenses increase unreasonably, at the same time restrains the farmer's reasonable health demand, and damages the fair development of the new rural cooperative medical system. This paper takes a county in Hunan Province as an example to explore the expression of moral hazard and the internal mechanism of moral hazard in the process of operation of the new rural cooperative medical system in the poor counties of Hunan province by means of case interview, participation observation method, literature analysis and so on. The expression of moral hazard is mainly discussed from three aspects: the medical demand side, the medical provider side and the medical supervision party. The internal mechanism is mainly explained from the particularity of the medical market, the unreasonable medical system and the individual opportunism tendency. Secondly, by using the data of China Health Statistics Yearbook from 2003 to 2013 to carry out advanced statistical analysis, this paper makes a deep analysis on whether the moral hazard problem exists in the whole country. Finally, it discusses how to avoid moral hazard from macro and micro levels. In order to find effective measures to solve moral hazard.
【学位授予单位】：湖南师范大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.1;F842.684;F323.89

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