新农合制度下农村基本医疗服务研究

发布时间：2018-03-09 09:23

本文选题：农村基本医疗服务　切入点：新农合制度　出处：《南京财经大学》2013年硕士论文　论文类型：学位论文

【摘要】：改革开放以来，我国农村经济取得了迅速发展，然而农村的基本医疗服务状况却不容乐观，“看病难、看病贵”依然是农村居民反映强烈、政府高度关注的社会问题，也是农村基本医疗服务领域内各种问题的集中体现。近年来政府加大对农村地区医疗卫生服务的投入力度，以改善农村地区的医疗服务供给状况，尤其是2003年开展新型农村合作医疗制度以来，一定程度上减轻了农村居民的疾病风险，提高了农村地区的基本医疗服务能力和水平。不过，广大农村居民的医疗服务需求在此制度下是否得以满足，新农合制度下的农村基本医疗服务供给绩效究竟如何，仍有待研究。本文以制度分析的视角，从制度主体（新农合医疗服务需求方、新农合医疗服务提供方和新农合管理经办机构）和制度执行（基金筹集、基金补偿和报销流程）对新农合制度予以全面分析，并利用搜集的相关数据绘制图表，从医疗卫生费用投入、农村医疗卫生资源以及农村医疗卫生服务等方面定量描述新农合制度下的农村基本医疗服务的供给现状。本文以安徽省怀宁县的具体调研情况为基础进行案例研究，从农村基本医疗服务的需求方出发，引入“满意度”的概念，探寻参合农民对新农合制度下农村基本医疗服务的认同度，包括新农合的起付线、报销比例、报销流程、医疗机构的设施设备、医护人员态度、医疗效果等。本文结合调研数据，采用因子分析模型，探讨参合农民对新农合制度下农村基本医疗服务的满意度测评，结果发现，参合农民对农村基本医疗服务满意度的综合得分是2.73分，，近68.7%的参合农民评价结果超过2.5分，大多数参合农民对新农合制度下的农村基本医疗服务还是比较认同的，不过在新农合的门诊补偿机制、新农合的报销效率以及村级卫生室的设施设备和医护人员的技术水平上还不尽满意。最后，本文对完善新农合制度下的农村基本医疗服务提出如下对策与建议：推进农村医疗保障制度改革，优化新农合制度，适当提高门诊补偿，提高新农合经办机构的办事效率；加强农村医疗卫生管理体制建设，加大对农村医疗卫生事业的财政支持力度，建立以公立医院为主的农村医疗卫生服务体系，加强农村医疗队伍建设。
[Abstract]:Since the reform and opening up, the rural economy of our country has made rapid development, but the condition of basic medical service in rural areas is not optimistic. "it is difficult to see a doctor and expensive to see a doctor" is still a social problem which is strongly reflected by rural residents and highly concerned by the government. In recent years, the government has increased its investment in medical and health services in rural areas in order to improve the supply of medical services in rural areas. Especially since the development of the new rural cooperative medical system in 2003, the disease risk of rural residents has been alleviated to some extent, and the ability and level of basic medical services in rural areas have been improved. However, Whether the rural residents' demand for medical services can be satisfied under this system, and what the performance of rural basic medical service supply under the new rural cooperative system is still to be studied. From the perspective of institutional analysis, this paper analyzes the main body of the system (the demand side of NCMS medical service, the provider of NCMS medical service and the NCMS management agency) and the system implementation (fund raising). Fund compensation and reimbursement process) to give a comprehensive analysis of the new rural cooperative system, and use the relevant data collected to chart, from the medical and health costs input, The rural medical and health resources and the rural medical and health services are quantitatively described in this paper. Based on the case study of Huining County in Anhui Province, this paper introduces the concept of "satisfaction" from the demand side of basic medical services in rural areas. To explore the farmers' recognition of the rural basic medical services under the new rural cooperative system, including the starting line, reimbursement ratio, reimbursement process, facilities and equipment of medical institutions, attitude of medical staff, medical effect, etc. Based on the investigation data and factor analysis model, this paper discusses the satisfaction degree of participating farmers to the rural basic medical service under the new rural cooperative system. The results show that the comprehensive score of the participating farmers' satisfaction with the rural basic medical services is 2.73 points. Nearly 68.7% of the participating farmers' evaluation results exceed 2.5 points. Most of the participating farmers still agree with the rural basic medical services under the New Rural Cooperation system. However, in the New Rural Cooperation system, the outpatient service compensation mechanism, The reimbursement efficiency of NCMS, the facilities of village-level clinics and the technical level of medical staff are not satisfactory. Finally, this paper puts forward the following countermeasures and suggestions to perfect the rural basic medical service under the new rural cooperative system: to promote the reform of the rural medical security system, to optimize the new rural cooperative system, and to increase the outpatient service compensation appropriately. To improve the efficiency of the NCMS agencies, to strengthen the construction of the rural medical and health management system, to increase the financial support for rural medical and health undertakings, and to establish a rural medical and health service system, which is dominated by public hospitals. We will strengthen the building of rural medical teams.
【学位授予单位】：南京财经大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;F842.684

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