新疆三地区城镇居民和新农合医疗保险运行状况比较分析及满意度研究

发布时间：2018-07-10 04:33

本文选题：医疗保险 + 运行状况　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:通过了解新疆乌鲁木齐市、阿克苏地区和伊犁地区的城镇居民和新农合医疗保险运行状况、乌鲁木齐市城乡医疗保险整合前后制度变化以及参保人员的满意度,对从中发现的问题进行梳理和总结,并为新疆医疗保险事业发展提供参考。方法:比较分析法在本文中分为纵向比较法和横向比较法。横向比较法是选择新疆乌鲁木齐市、伊犁地区和阿克苏地区的医疗保险制度进行横向比较研究。纵向比较法是通过分析新疆三地区近几年的制度运行情况,发现其存在的问题。采用自行设计的问卷对参加乌鲁木齐市、阿克苏地区和伊犁地区的城镇居民和新农合医疗保险的参保人员进行认知度和满意度调查。结果:从城镇居民参保人数来看,乌鲁木齐市的参保人数逐年增加,2015年增加到60.08万人;阿克苏地区的参保人数在2015年上升到了29.19万人;伊犁地区的参保人数在2015年为31.70万人。从新农合参保人数来看,乌鲁木齐市的参保人数在2015年增长到24.60万人,参保率99.98%;阿克苏地区的参保人数在2015年增长到154.23万人,参保率99.81%;伊犁地区的参保人数在2015年增长到142.86万人,参保率99.40%。乌鲁木齐市和阿克苏地区的缴费人数增加;伊犁地区的缴费人数处于不稳定状态。三地区的缴费金额逐年增加。财政补助方面,应补和实补数据不一致,有基金未到位情况。城镇居民和新农合医保2015年和2016年进行比较,不管在起付线标准方面上,还是在报销比例或者在封顶线上三地都设置了不同的标准。由城镇居民医保费用支出和享受待遇人数表可以看出,各地区的人均统筹支付和受益率起伏不定。新农合中阿克苏地区和伊犁地区的门诊受益率升高,门诊金额在27元左右;阿克苏地区的住院受益率升高,住院人均补助金额在1900元左右;伊犁地区的住院受益率不稳定,与住院人数相关,住院补助金额基本在上升。在分析不同参保人员医疗保险认知中,每年需要缴纳的医保金额得分有统计学意义(P0.05);从总的得分均值可以看出,两组参保人员对医保的认知得分没有统计学差异,认知水平较低。参保人员对医疗保险制度分项目的满意情况分析中均没有统计学意义(P0.05);从均值得出,两组参保人员对医疗保险分项目满意度都处于不满意水平,分值在2.4左右。在不同特征参保人员满意度得分分析中,民族、年龄、文化水平、家庭负担及首选医院类型有统计学意义(P0.05)。参保人员满意度多因素Logistic回归分析,了解度、民族、首选医院有统计学意义(P0.05)。结论:三地区医保制度逐年完善,其中乌鲁木齐参保人数、财政补助、医保相关认知均高于阿克苏地区伊犁及伊犁地区。乌鲁木齐市和阿克苏地区的封顶线设置过低,伊犁地区不封顶,设置太高,医保制度尚不完善。三地区医保收益过低,未能满足参保人员对报销的期望值,将会影响参保人员参保的积极性。居民对医保相关认知不足,应加强宣传教育。医疗保险满意度与定点医院有关。
[Abstract]:Objective: through understanding the operation status of urban residents and new rural cooperative medical insurance in Urumqi, Akesu and Yili, the changes of the system of medical insurance before and after the integration of urban and rural medical insurance in Urumqi and the satisfaction of the insured persons, the problems found in the medical insurance are summarized and summarized, and the development of medical insurance in Xinjiang is provided. Method: the comparative analysis method is divided into vertical comparison method and lateral comparison method in this paper. The lateral comparison method is to choose the medical insurance system of Urumqi, Yili and Akesu in Xinjiang. The longitudinal comparison method is to find the existence of the system in the three region of Xinjiang in recent years. A self-designed questionnaire was used to investigate the awareness and satisfaction of the urban residents in Urumqi, Akesu and Yili areas and the medical insurance of NCMS. Results: from the number of urban residents, the number of participants in Urumqi increased year by year, and increased to 600 thousand and 800 people in 2015, Akesu. The number of participants in the region rose to 291 thousand and 900 in 2015; the insured number in Yili was 317 thousand in 2015. From the number of new rural cooperation, the number of participants in Urumqi increased to 246 thousand in 2015, and the insured rate was 99.98%; the number of participants in the Akesu region increased to 1 million 542 thousand and 300 in 2015, and the participation rate was 99.81%; Yili The number of participants in the region increased to 1 million 428 thousand and 600 in 2015, the participation rate of 99.40%. in Urumqi and Akesu increased; the contributors in the Yili region were in an unstable state. The amount of payment in the three region increased year by year. Compared with the medical insurance of NCMS in 2015 and 2016, different standards have been set up in terms of the standards of the starting and payment lines, the proportion of reimbursement or the three places on the top of the capped line. The outpatient benefit rate of the area of Yili and Yili is higher, the outpatient amount is about RMB yuan, the benefit rate of hospitalization in Akesu area is higher, the per capita subsidy amount is about 1900 yuan, the inpatient benefit rate in Yili area is unstable, the hospitalization is related to the number of hospitalization subsidy Jin Eji, and the medical insurance of different insured persons is analyzed. The score of medical insurance amount needed to be paid annually is statistically significant (P0.05). From the total score, there is no statistical difference in the cognitive score of the two groups of insured persons, and the level of cognition is low. There is no statistical significance (P0.05) in the satisfaction analysis of the medical insurance system for the insured persons (P0.05). The satisfaction of the two groups of insured persons was not satisfied with the level of satisfaction of the medical insurance sub projects. The score was about 2.4. In the analysis of the satisfaction scores of the different characteristics of the insured persons, there were statistical significance (P0.05) for the nationality, age, cultural level, family burden and first choice hospital type. The multiple factor Logistic regression analysis for the satisfaction of the insured persons, and the degree of understanding, The first choice hospital has statistical significance (P0.05). Conclusion: the medical insurance system in three areas is perfected year by year. Among them, the number of Urumqi insured, financial subsidy and medical insurance are higher than that of Yili and Yili in Akesu region. The capping line in Urumqi and Akesu area is too low, the Yili area is not sealed and the medical insurance system is too high. It is not perfect. The low income of medical insurance in three areas is too low to meet the expected value of the insured personnel for reimbursement. It will affect the enthusiasm of the insured persons. The residents' cognition of medical insurance is insufficient, and the publicity and education should be strengthened. The satisfaction of medical insurance is related to the designated hospital.
【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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