新型农村合作医疗制度“郑州模式”研究

发布时间：2018-03-24 01:12

本文选题：新型农村合作医疗制度　切入点：管办分离　出处：《郑州大学》2013年硕士论文

【摘要】：新型农村合作医疗制度是发展我国农村地区医疗卫生事业的一项重要举措,2003年开始试点工作,目前仍处于完善之中,运行机制的健全关系到新农合制度是否可以持续健康发展。自试点以来,多个地区不断探索适合本地区发展的运行模式。河南新乡、洛阳分别在2003年和2007年进行了新农合制度经办机制改革,通过购买服务的方式将新农合支付审核业务委托给商业保险机构办理,形成了具有示范效应的“新乡模式”和“洛阳模式”。2011年,郑州借鉴新乡、洛阳新农合制度的发展经验,进行了委托商业保险机构经办新农合业务的改革,形成了省会城市新农合制度“管办分离”的“郑州模式”。 “郑州模式”证明了省会城市委托商业保险机构经办新农合业务的可行性,对“郑州模式”进行系统总结可以更好的推广郑州新农合制度的发展经验,完善我国的新农合制度。郑州作为我国第一批新农合制度试点地区之一,其新农合业务发展迅速,呈现出了保障水平不断上升、筹资标准逐年提高和补偿比例趋于优化的特点；在郑州新农合制度不断完善的同时,为了保障新农合制度的可持续发展,郑州进行了新农合经办机制改革,其具体措施包括优化服务机制、建立合理的补偿机制、完善监管机制和科学控制新农合基金运行；郑州新农合经办机制改革呈现出了四个创新：开创省会城市新农合改革先河、公开招标降低人力成本、创新用人机制和健全商业补充保险。这些创新使“郑州模式”具有审核简便、标准统一、运行高效、监管有力和保障全面的优点,可以使政府、保险公司、农民和医疗机构四个层面获得利益,具有推广价值。然而,“郑州模式”还存在着法律支持缺位、沟通机制不畅、补偿标准不统一和保障金额不高的问题。要完善“郑州模式”,需遵循以农民根本利益为出发点、以健全我国社会保障体系为目标的原则,完善相关法律法规、加深各部门之间的沟通、优化新农合制度设计和加强对医疗机构的监管。本研究的可能创新之处：第一,系统总结“郑州模式”的发展历程、特点及创新点,探索“郑州模式”的复制价值；第二,探讨“郑州模式”的缺陷和不足,并提出政策建议,以期为新农合制度“郑州模式”的完善提供决策参考。
[Abstract]:The new rural cooperative medical system is an important measure to develop the medical and health services in rural areas of China. The pilot work began in 2003 and is still in the process of perfection. The sound operation mechanism is related to the sustainable and healthy development of the new agricultural cooperation system. Since the pilot, many regions have been exploring the operation mode suitable for the development of their own areas. In 2003 and 2007 respectively, Luoyang carried out the reform of the management mechanism of the new rural cooperative cooperation system, and entrusted the new rural cooperative payment audit business to the commercial insurance institutions through the purchase of services. "Xinxiang Model" and "Luoyang Model" with demonstration effect have been formed. In 2011, Zhengzhou adopted the experience of Xinxiang and Luoyang New Rural Cooperation system and carried out the reform of entrusting commercial insurance institutions to run new rural cooperative business. Formed the provincial capital city new agricultural cooperation system "management separation", "Zhengzhou mode". "Zhengzhou mode" proves the feasibility of entrusting commercial insurance institutions to run the new agricultural cooperative business in provincial capitals, and the development experience of Zhengzhou new agricultural cooperation system can be better promoted by systematically summing up the "Zhengzhou model". Zhengzhou, as one of the first pilot areas of the new agricultural cooperation system, has developed rapidly, showing the characteristics of increasing the level of guarantee, raising the standard of financing year by year and the proportion of compensation tending to be optimized. In order to ensure the sustainable development of the new agricultural cooperation system, Zhengzhou has carried out the reform of the new agricultural cooperation management mechanism. The concrete measures include optimizing the service mechanism and establishing a reasonable compensation mechanism. Improving the supervision mechanism and scientifically controlling the operation of the new rural cooperative fund; the reform of Zhengzhou new rural cooperative fund system presents four innovations: to create the new rural cooperation reform in the provincial capital city, to open the public bidding to reduce the labor cost, Innovative employment mechanisms and sound commercial supplementary insurance. These innovations make the "Zhengzhou model" have the advantages of simple auditing, uniform standards, efficient operation, strong supervision and comprehensive protection, which can enable the government and insurance companies, Farmers and medical institutions gain benefits at four levels, which is worth popularizing. However, there is a lack of legal support and poor communication mechanism in Zhengzhou Model. In order to perfect the Zhengzhou Model, we should follow the principle of taking the fundamental interests of farmers as the starting point and taking the perfection of our social security system as the goal, and perfect the relevant laws and regulations. Deepen the communication between departments, optimize the design of the new rural cooperative system and strengthen the supervision of medical institutions. The possible innovations of this study are as follows: first, systematically summarize the development course, characteristics and innovation points of Zhengzhou Model, explore the replicating value of Zhengzhou Model; second, discuss the defects and shortcomings of Zhengzhou Model. Policy suggestions are put forward in order to provide decision-making reference for the perfection of Zhengzhou model of the new agricultural cooperation system.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;F842.684;R197.1

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