长春市新型农村合作医疗制度运行现状及对策研究
发布时间：2019-06-01 20:52
【摘要】：我国农村人口众多,农村居民的健康状况对国民整体健康水平具有重要影响,一定程度上决定了我国社会与经济能否稳定发展,也决定我国能否实现现代化建设的要求。随着新农合的逐步发展,使得农民在看大病治大病上的负担得到一定缓解,越来越多的农民积极参与该项制度。巩固发展新农合制度,提高参合农民的受益水平,减轻个人自费医药费用负担,一直以来都是深化农村医药卫生体制改革的关键。【目的】本研究从参合情况、基金的筹集与支出情况、费用补偿、层级转诊与大病保险等方面,全方位实证分析长春市2014年的新型农村合作医疗制度的整体运行现状,客观评价取得的成效,深入剖析影响参合农民受益水平的主要原因及其存在的问题,有针对性的提出完善长春市新型农村合作医疗制度的政策建议与对策,从而为其可持续发展提供理论依据。【方法】采用文献研究和实证调查结合的方法,以人均筹资水平、人均缴费、参合率、受益率、人均缴费占人均纯收入的比重、基金使用率、实际补偿比、住院费用和次均住院补偿比为评价指标进行综合分析,本文所用数据、资料来源为长春市2014年新农合制度运行情况的相关指标数据与文件资料。采用SPSS13.0统计软件进行数据的录入与分析,统计方法为描述性分析。【结果】长春市新农合参合情况:长春市已实现新农合制度全覆盖,参合率达到98.56%。基金筹集以中央财政筹资为主,占43.90%,省级与个人筹资分别占22.20%、21.59%;个人筹资金额为90元,个人缴费占人均纯年收入的比例为0.89%。长春市新农合基金使用方面:长春市新农合基金按照吉林省补偿方案进行分配,以住院统筹基金为主,占72.20%。基金住院支出为86.61%,门诊支出为13.39%。长春市参合农民受益方面:从受益人次上看,长春市新农合基金补偿受益以门诊为主,受益率为27.00%,住院受益率为9.3%;从门诊受益上看,长春市新农合基金门诊实际补偿比为68.71%,次均门诊费用267.38元;从住院受益上看,住院实际补偿比为47.36%,次均住院费用为7069.45元。乡镇、县级、市级、省级、省外医疗机构住院补偿比分别为71.38%、61.91%、40.76%、37.84%、33.58%。长春市层级转诊效果方面:实行层级转诊管理后,2014年上半年市级医疗机构的新农合患者住院人次明显增加,增长率为22.86%。省级医疗机构的住院费用与自付费用比例皆高于市级医疗机构。以长春市中心医院为例,住院人次明显增加,2014年上半年,住院人次2536人,比2013年上半年增长了近两倍。大病保险补偿情况:长春市大病保险补偿人次为38387人,次均补偿金额为3893.38元,大病补偿前实际补偿比为43.57%,大病保险后实际补偿比为54.25%。【结论】长春市新型农村合作医疗制度个人筹资比例较为合理;但住院实际补偿比与政策补偿比差距较大,受益水平还需进一步的提高;大病保险制度实施后,虽然补偿水平有所提高,但农民仍然需要缴纳近一半的医疗费用,所以并未从根本上减轻农民的就医负担;长春市新农合实行层级转诊制度以来,在参合农民在定点医院住院人次的变化方面取得较好的效果,该制度是否值得进一步推行,还需要全方位的考察评价。针对长春市新农合运行现状,需要在完善新农合筹资补偿机制与支付方式、加强基层医疗机构服务能力等方面采取措施,以提高其运行效果。
[Abstract]:The rural population in China has a large population, the health status of the rural residents has an important influence on the overall health level of the population, and the stable development of the society and the economy of our country is determined to some extent, and it also determines whether our country can meet the requirements of the modernization construction. With the gradual development of the new agriculture, the burden on the large-scale diseases of the farmers is relieved, and more and more farmers are actively involved in the system. The key to the reform of the rural medical and health system has been to consolidate the development of the new farming system, to improve the beneficiary level of the farmers and to reduce the burden on the medical expenses at the expense of the individual at his own expense. [Objective] To analyze the overall operation status and objective evaluation of the new rural cooperative medical system in Changchun in 2014 from the aspects of participation, fund raising and expenditure, cost compensation, level referral and major disease insurance. In this paper, the main causes and problems of the benefit level of the new rural cooperative medical service in Changchun are analyzed in depth, and the policy suggestions and countermeasures to perfect the new rural cooperative medical system in Changchun are put forward, so as to provide the theoretical basis for the sustainable development of the rural cooperative medical system. [Methods] The method of combining the literature research and the empirical investigation, based on the per capita raising level, per capita contribution, participation rate, benefit rate, the specific gravity of per capita net income, the fund utilization rate and the actual compensation ratio, In this paper, the data and data are the relevant index data and file data of the operation of the new non-agricultural system in Changchun in 2014. The data is input and analyzed by using the SPSS13.0 statistical software, and the statistical method is a descriptive analysis. [Results] The status of the new non-agricultural co-operation in Changchun: the full coverage of the new farming system has been realized in Changchun, and the participation rate is 98.56%. The fund raised the central financial fund as the main, accounting for 43.90%, the provincial and individual funds account for 22.20%, 21.59% respectively; the individual financing amount is 90 yuan, and the proportion of the individual contribution to the per capita net annual income is 0.89%. With respect to the use of the New Agriculture Fund in Changchun, the new agriculture and closing fund of Changchun is distributed according to the compensation plan of Jilin Province, and the hospitalization and integration fund is the main, accounting for 72.20%. The hospitalization expenditure of the Fund was 86.61% and the outpatient expenditure was 13.39%. The benefit of Changchun participating farmers: from the beneficiary, the benefit rate of the new farmers in Changchun is the outpatient service, the benefit rate is 27.00%, the benefit rate of the hospital is 9.3%, the actual compensation ratio of the outpatient service of the new non-agricultural fund in Changchun is 68.71%, and the secondary average outpatient service cost is 267.38 yuan; From the benefit of the hospital, the actual compensation rate of the hospital was 47.36%, and the hospitalization cost was 7069.45 yuan. The compensation ratio of the hospital in the township, county, municipal, provincial and provincial medical institutions was 71.38%, 61.91%, 40.76%, 37.84% and 33.58%, respectively. The effect of the level transfer in Changchun: after the implementation of the level referral management, the number of patients in the hospital in the first half of 2014 was significantly increased and the growth rate was 22.86% in the first half of 2014. The proportion of resident and out-of-pocket expenses of the provincial medical institution is higher than that of the municipal medical institution. Take the central hospital of Changchun as an example, the number of people in the hospital is obviously increased. In the first half of 2014, there were 2536 people in the hospital, nearly two times higher than the first half of 2013. The compensation for large disease insurance was 38387 in Changchun, the compensation rate was 3893.38 yuan, the actual compensation rate was 43.57%, and the actual compensation rate was 54.25% after major disease insurance. [Conclusion] The proportion of individual fund raising of the new rural cooperative medical system in Changchun is reasonable; but the actual compensation ratio of the hospital is larger than that of the policy compensation ratio, and the benefit level needs to be further improved; after the implementation of the large disease insurance system, although the compensation level is improved, However, the farmers still need to pay nearly half of the medical expenses, so they do not fundamentally reduce the burden on the medical treatment of the farmers. Since the establishment of the level referral system in Changchun, the farmers have achieved good results in the change of the number of people in the fixed-point hospital. Whether the system is worth further implementation, and also need an all-round inspection and evaluation. In view of the current situation of the new agriculture in Changchun, it is necessary to take measures to improve the service ability of the grass-roots medical institutions in order to improve the operation effect.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.1;F323.89
[Abstract]:The rural population in China has a large population, the health status of the rural residents has an important influence on the overall health level of the population, and the stable development of the society and the economy of our country is determined to some extent, and it also determines whether our country can meet the requirements of the modernization construction. With the gradual development of the new agriculture, the burden on the large-scale diseases of the farmers is relieved, and more and more farmers are actively involved in the system. The key to the reform of the rural medical and health system has been to consolidate the development of the new farming system, to improve the beneficiary level of the farmers and to reduce the burden on the medical expenses at the expense of the individual at his own expense. [Objective] To analyze the overall operation status and objective evaluation of the new rural cooperative medical system in Changchun in 2014 from the aspects of participation, fund raising and expenditure, cost compensation, level referral and major disease insurance. In this paper, the main causes and problems of the benefit level of the new rural cooperative medical service in Changchun are analyzed in depth, and the policy suggestions and countermeasures to perfect the new rural cooperative medical system in Changchun are put forward, so as to provide the theoretical basis for the sustainable development of the rural cooperative medical system. [Methods] The method of combining the literature research and the empirical investigation, based on the per capita raising level, per capita contribution, participation rate, benefit rate, the specific gravity of per capita net income, the fund utilization rate and the actual compensation ratio, In this paper, the data and data are the relevant index data and file data of the operation of the new non-agricultural system in Changchun in 2014. The data is input and analyzed by using the SPSS13.0 statistical software, and the statistical method is a descriptive analysis. [Results] The status of the new non-agricultural co-operation in Changchun: the full coverage of the new farming system has been realized in Changchun, and the participation rate is 98.56%. The fund raised the central financial fund as the main, accounting for 43.90%, the provincial and individual funds account for 22.20%, 21.59% respectively; the individual financing amount is 90 yuan, and the proportion of the individual contribution to the per capita net annual income is 0.89%. With respect to the use of the New Agriculture Fund in Changchun, the new agriculture and closing fund of Changchun is distributed according to the compensation plan of Jilin Province, and the hospitalization and integration fund is the main, accounting for 72.20%. The hospitalization expenditure of the Fund was 86.61% and the outpatient expenditure was 13.39%. The benefit of Changchun participating farmers: from the beneficiary, the benefit rate of the new farmers in Changchun is the outpatient service, the benefit rate is 27.00%, the benefit rate of the hospital is 9.3%, the actual compensation ratio of the outpatient service of the new non-agricultural fund in Changchun is 68.71%, and the secondary average outpatient service cost is 267.38 yuan; From the benefit of the hospital, the actual compensation rate of the hospital was 47.36%, and the hospitalization cost was 7069.45 yuan. The compensation ratio of the hospital in the township, county, municipal, provincial and provincial medical institutions was 71.38%, 61.91%, 40.76%, 37.84% and 33.58%, respectively. The effect of the level transfer in Changchun: after the implementation of the level referral management, the number of patients in the hospital in the first half of 2014 was significantly increased and the growth rate was 22.86% in the first half of 2014. The proportion of resident and out-of-pocket expenses of the provincial medical institution is higher than that of the municipal medical institution. Take the central hospital of Changchun as an example, the number of people in the hospital is obviously increased. In the first half of 2014, there were 2536 people in the hospital, nearly two times higher than the first half of 2013. The compensation for large disease insurance was 38387 in Changchun, the compensation rate was 3893.38 yuan, the actual compensation rate was 43.57%, and the actual compensation rate was 54.25% after major disease insurance. [Conclusion] The proportion of individual fund raising of the new rural cooperative medical system in Changchun is reasonable; but the actual compensation ratio of the hospital is larger than that of the policy compensation ratio, and the benefit level needs to be further improved; after the implementation of the large disease insurance system, although the compensation level is improved, However, the farmers still need to pay nearly half of the medical expenses, so they do not fundamentally reduce the burden on the medical treatment of the farmers. Since the establishment of the level referral system in Changchun, the farmers have achieved good results in the change of the number of people in the fixed-point hospital. Whether the system is worth further implementation, and also need an all-round inspection and evaluation. In view of the current situation of the new agriculture in Changchun, it is necessary to take measures to improve the service ability of the grass-roots medical institutions in order to improve the operation effect.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.1;F323.89
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相关期刊论文 前10条
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