【摘要】：新型農(nóng)村合作醫(yī)療作為國(guó)家醫(yī)療衛(wèi)生事業(yè)發(fā)展的一項(xiàng)重大舉措,已經(jīng)走過(guò)近十個(gè)年頭。在這十年里,農(nóng)村的醫(yī)療保障事業(yè)發(fā)生了從無(wú)至有質(zhì)的轉(zhuǎn)變。但醫(yī)療費(fèi)用過(guò)快增長(zhǎng)使農(nóng)民的補(bǔ)償收益大打折扣。雖然新型農(nóng)村合作醫(yī)療的補(bǔ)償比例在逐年提高,但農(nóng)民看病貴的問(wèn)題并沒(méi)有得到實(shí)際緩解,新農(nóng)合每年給農(nóng)民增加的補(bǔ)償大部分被醫(yī)療費(fèi)用的上漲所抵消,探究造成醫(yī)療費(fèi)用上漲的原因,傳統(tǒng)按醫(yī)療服務(wù)項(xiàng)目付費(fèi)方式存在種種缺陷,使得各地已經(jīng)開(kāi)始探索各種醫(yī)療支付方式的改革,支付方式由后付制向預(yù)付制轉(zhuǎn)變、多元化的付費(fèi)選擇是改革的方向。 陜西省旬邑縣于2010年3月開(kāi)始新農(nóng)合支付方式改革試點(diǎn),是全國(guó)較早的對(duì)于住院統(tǒng)籌實(shí)行總額預(yù)付制的試點(diǎn)縣。本文就是在對(duì)旬邑縣新型農(nóng)村合作醫(yī)療住院統(tǒng)籌總額預(yù)付制試點(diǎn)運(yùn)行情況了解的基礎(chǔ)上,通過(guò)實(shí)地調(diào)研和專家訪談,獲得第一手的運(yùn)行數(shù)據(jù)和材料,試圖求證總額預(yù)付制在實(shí)踐過(guò)程中取得的成效和存在的問(wèn)題,為新農(nóng)合支付方式進(jìn)一步改革提供實(shí)證依據(jù)。本文通過(guò)對(duì)旬邑縣住院費(fèi)用總額預(yù)付制改革運(yùn)行情況進(jìn)行分析與討論,重點(diǎn)對(duì)比改革前后總額預(yù)付制對(duì)醫(yī)療費(fèi)用控制、新農(nóng)合經(jīng)辦機(jī)構(gòu)、定點(diǎn)醫(yī)療機(jī)構(gòu)、參合農(nóng)民產(chǎn)生的影響,并發(fā)現(xiàn)問(wèn)題。針對(duì)問(wèn)題,分析產(chǎn)生問(wèn)題的根源,提出總額測(cè)算是關(guān)系總額預(yù)付制度運(yùn)行效果的最重要因素,總額預(yù)付制的難點(diǎn)和核心在于科學(xué)合理的總額測(cè)算。探索有針對(duì)性的解決方法,并提出完善住院費(fèi)用總額預(yù)付制的對(duì)策建議,即應(yīng)加強(qiáng)醫(yī)院服務(wù)的考核與管理、選擇合適的測(cè)算方法并確保相關(guān)配套措施的協(xié)調(diào)調(diào)動(dòng)。最后,總結(jié)并提煉出值得借鑒的經(jīng)驗(yàn)、教訓(xùn)和需要進(jìn)一步研究的問(wèn)題,為實(shí)現(xiàn)總額預(yù)付制的規(guī)范化、科學(xué)化發(fā)展及支付方式的進(jìn)一步改革提供實(shí)證依據(jù),為西部其它地區(qū)相關(guān)政策的制定提供參考和借鑒,以期推廣。
[Abstract]:As an important measure in the development of national medical and health care, the new rural cooperative medical system has gone through nearly ten years. In this decade, rural health care has undergone a qualitative transformation from nil. However, the rapid growth of medical costs has greatly reduced the compensation benefits of farmers. Although the proportion of compensation for the new rural cooperative medical care is increasing year by year, the problem of farmers' expensive medical treatment has not actually been alleviated. The annual increase in compensation provided by NCMS to farmers is largely offset by the increase in medical costs. To explore the causes of the rise in medical expenses, there are various defects in the traditional method of paying for medical services according to the items of medical services, which has led to the exploration of the reform of various medical payment methods in various places, and the change of payment methods from the back payment system to the prepaid system. Diversification of payment options is the direction of reform. Xunyi County of Shaanxi Province began the pilot reform of the new rural cooperative payment system in March 2010. This paper is based on the understanding of the pilot operation of the new rural cooperative medical system in Xunyi County, through field research and expert interviews, to obtain first-hand operation data and materials. This paper attempts to prove the effectiveness and problems of the total advance payment system in the process of practice, and provide an empirical basis for the further reform of the new rural cooperative payment system. Through the analysis and discussion of the operation of the reform of the total advance system of hospital expenses in Xunyi County, this paper focuses on the comparison of the effects of the total advance system on the control of medical expenses, the new rural cooperative agencies, the designated medical institutions, and the participating farmers before and after the reform. And discover the problem. In view of the problem, this paper analyzes the root cause of the problem, and puts forward that the calculation of total amount is the most important factor in the operation effect of the total advance payment system. The difficulty and core of the total advance payment system lies in the scientific and reasonable calculation of the total amount. This paper explores the relevant solutions, and puts forward some countermeasures and suggestions to improve the system of total advance payment of hospital expenses, that is, to strengthen the examination and management of hospital services, to select the appropriate calculation methods and to ensure the coordinated mobilization of relevant supporting measures. Finally, it summarizes and abstracts the experiences, lessons and problems that need further study, which provides the empirical basis for the standardization, scientific development and the further reform of the payment method. To provide reference and reference for the formulation of relevant policies in other regions of the west, with a view to promoting.
【學(xué)位授予單位】：西北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：F323.89;R197.1;F842.684

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