本文選題：麒麟?yún)^(qū) + 新型農(nóng)村合作醫(yī)療��； 參考：《昆明醫(yī)科大學》2014年碩士論文

【摘要】：目的 通過分析云南省曲靖市麒麟?yún)^(qū)新農(nóng)合鄉(xiāng)級住院免費醫(yī)療運行現(xiàn)狀和鄉(xiāng)級住院免費醫(yī)療制度的可行性,綜合評價鄉(xiāng)級住院免費醫(yī)療醫(yī)療制度實施的成功經(jīng)驗和存在問題,有針對性地提出合理化建議,為有關(guān)部門進一步完善新型農(nóng)村合作醫(yī)療制度,建立持續(xù)、健康、穩(wěn)步發(fā)展的新型農(nóng)村合作醫(yī)療制度提供科學依據(jù)。 方法 采用流行病學橫斷面調(diào)查進行研究。通過報表和調(diào)查表收集麒麟?yún)^(qū)2012年、2013年的新型農(nóng)村合作醫(yī)療資料；以分層抽樣方法抽取東山鎮(zhèn)和西城街道2個樣本；以問卷調(diào)查方式隨機抽取2個樣本醫(yī)院和區(qū)外定點醫(yī)療機構(gòu)參合的住院患者656人,了解他們對新型農(nóng)村合作醫(yī)療制度補償方案等的意見和建議；對區(qū)鄉(xiāng)級新農(nóng)合管理人員進行訪談。全部資料均采用SPSS統(tǒng)計軟件包進行分析。 結(jié)果 1.曲靖市麒麟?yún)^(qū)新農(nóng)合鄉(xiāng)級住院運行狀況2013年參合患者在鄉(xiāng)級定點醫(yī)療機構(gòu)住院治療住院醫(yī)藥費用按起付線200元,報銷比例100%報銷,實行現(xiàn)場即時補償。2013年鄉(xiāng)級住院31741人次,占住院總?cè)舜蔚?2.25%；住院補償2779.90萬元,占住院補償總費用的23.55%；鄉(xiāng)級住院總費用為3207.21萬元,與2012年同期2031.63萬元相比,上漲1175.58萬元,增長57.86%；次均住院費用為1010.40元,與2012年同期798.90元相比,上漲211.5元,增長26.47%。 2.住院患者對當前就診醫(yī)院和鄉(xiāng)級住院免費醫(yī)療制度基本情況的知曉程度、態(tài)度的評價西城街道社區(qū)衛(wèi)生服務(wù)中心、東山鎮(zhèn)中心衛(wèi)生院和區(qū)外醫(yī)院的的住院患者對其就診醫(yī)院的評價項目都存在統(tǒng)計學差異。65.4%的住院患者對當前就診醫(yī)院總體滿意�；颊邔︵l(xiāng)級住院免費醫(yī)療基本情況知曉程度存在統(tǒng)計學差異,知曉程度最高的是西城社區(qū)衛(wèi)生服務(wù)中心住院患者,其次是東山鎮(zhèn)衛(wèi)生院住院患者,區(qū)外的住院患者知曉程度最低。 3.對鄉(xiāng)級住院免費醫(yī)療制度的態(tài)度和定點醫(yī)療機構(gòu)變化情況的評價住院患者對麒麟?yún)^(qū)實施鄉(xiāng)級住院免費醫(yī)療制度的態(tài)度都存在統(tǒng)計學差異,66.6%住院患者支持開展鄉(xiāng)級住院免費醫(yī)療制度。住院患者對實施鄉(xiāng)級住院免費醫(yī)療制度后醫(yī)療機構(gòu)整體變化在服務(wù)態(tài)度、醫(yī)療設(shè)備、醫(yī)技水平、服務(wù)質(zhì)量、服務(wù)流程的評價都有統(tǒng)計學差異。 4.新農(nóng)合管理人員對實施鄉(xiāng)級住院免費醫(yī)療制度的評價新農(nóng)合管理人員對實施免費醫(yī)療制度的態(tài)度與參合患者不完全一致,管理人員認為在目前的醫(yī)療條件下,實施免費醫(yī)療制度最大的困難是政府對基層醫(yī)療機構(gòu)投入不足和衛(wèi)生技術(shù)人員缺乏。從2013年住院病人流向與2012年相比看,通過實施免費醫(yī)療制度來控制病人區(qū)外就診率有一定的效果。 結(jié)論 麒麟?yún)^(qū)新農(nóng)合鄉(xiāng)級住院免費醫(yī)療經(jīng)過一年的運行,住院人次、補償資金都比2012年增長。從2013年麒麟?yún)^(qū)住院病人流向與2012年相比看,省、市、鄉(xiāng)級住院人次數(shù)分別增加了286、2425、6311人次,區(qū)級減少491人次,通過實施免費醫(yī)療制度來控制病人區(qū)外就診率有一定的效果。但是同時也帶來了門診轉(zhuǎn)住院、小病大養(yǎng)、次均住院費用上漲的問題。隨著人均籌資標準逐年提高,在確�；鸢踩那疤嵯�,適當提高基層醫(yī)療機構(gòu)的報銷比例,有利于緩解“看病難”的難題,更多的惠及參合群眾,有利于新農(nóng)合制度持續(xù)、健康發(fā)展。
[Abstract]:objective
Through the analysis of the current status of the free medical operation in the nncms and the feasibility of the free medical system in the township level in Kirin District, Qujing, Yunnan, the successful experience and problems of the implementation of the free medical system in the township level are comprehensively evaluated, and the rationalization proposals are put forward to improve the new rural cooperation for the relevant departments. To provide a scientific basis for the establishment of a new rural cooperative medical system with continuous, healthy and steady development as a medical system.
Method
The epidemiological cross-sectional survey was used to collect the data of the new rural cooperative medical service in kylin District in 2012 and 2013. 2 samples of Dongshan and Xicheng streets were sampled by stratified sampling method, and 65 hospitalized patients with 2 sample hospitals and outside fixed-point medical institutions were randomly selected by questionnaire. 6 people know their opinions and suggestions on the compensation scheme for the new rural cooperative medical system, and interview the management personnel of the new rural cooperative medical system in the district. All the data are analyzed by the SPSS software package.
Result
1. the operation status of the NCMS in Kirin District, Qujing, in 2013, the hospitalized medical expenses of the participants in the local medical institutions were 200 yuan, the reimbursement ratio was 100%, 31741 people were hospitalized in.2013 years, accounting for 52.25% of the total number of inpatients and 27 million 799 thousand yuan in hospitalization, which accounted for the hospitalization compensation. The total cost was 23.55%. The total cost of rural hospitalization was 32 million 72 thousand and 100 yuan. Compared with 20 million 316 thousand and 300 yuan in the same period in 2012, the total cost was 11 million 755 thousand and 800 yuan, up 57.86%, and the average hospitalization cost was 1010.40 yuan. Compared with 798.90 yuan in the same period in 2012, it was up 211.5 yuan, up 26.47%.
2. the awareness of the basic situation of the free medical system in the hospitalized hospital and the local hospital, the assessment of the attitude of the Xicheng Street Community Health Service Center, the Central Health Hospital of Dongshan Town and the hospital in the outpatient hospital for the evaluation of the hospitalized hospital, the hospitalized patients with the difference of.65.4% were present for the current medical treatment. The general satisfaction of the hospital was satisfactory. There was a statistical difference between the patients' awareness of the basic situation of free medical care in the township level. The highest awareness was the inpatients in the Xicheng community health service center, followed by the inpatients in the Dongshan Township Hospital, and the lowest level of awareness of the inpatients outside the district.
3. the attitude of the free medical system in the township level and the change of the designated medical institutions, the attitude of the hospitalized patients to the free medical system in the kylin district was statistically different, and 66.6% of the hospitalized patients supported the free medical system in the township level. The overall changes in medical institutions were statistically different in terms of service attitude, medical equipment, medical skill level, service quality and service process.
4. the evaluation of the new rural cooperation management personnel to implement the free medical system at the township level. The attitude of the new rural cooperative management personnel to the implementation of the free medical system is not exactly the same as those of the participants. Under the current medical conditions, managers believe that the biggest difficulty in implementing the free medical system is the insufficient investment and health technology of the government to the grass-roots medical institutions. From 2013, compared with 2012, the implementation of free medical care system has a certain effect in controlling outpatient visits.
conclusion
The free medical treatment of the nncms in Kirin District was run after one year, and the amount of compensation was increased than in 2012. From 2013 to 2012, the number of inpatients in the Kirin District was increased by 28624256311, the district level was 491 times, and the patients were controlled by the free medical system to control the patients. But at the same time, it also brought about the problem of the outpatient transfer to the hospital, the small illness and the increase of the cost of hospitalization. With the increase of the per capita fund raising standard, the proportion of the reimbursement for the medical institutions at the grass-roots level should be properly improved on the premise of ensuring the security of the fund. The masses are conducive to the sustained and healthy development of the new rural cooperative medical system.

【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R197.1;F323.89;F842.684

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