武汉市新农合大病保险实施效果评价
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摘要
目的:提高新农合的科学运行与管理。方法:总结武汉市新农合大病保险工作的做法与成效,对武汉市新农合大病保险的实施效果进行评价,分析存在的问题,提出解决措施。结果:2014年武汉市全面启动了新农合大病保险工作,通过加强资金管理、规范基础工作、推进合署办公、加强政策宣传及稳步开展好理赔服务等措施,大病保险赔付工作进展顺利,参合农民住院实际补偿率显著提高(P<0.01);基金支出以普通住院补偿为主;人口规模小的区出现基金透支,但由于采取了市级统筹政策,化解平衡了区域性风险。结论:新农合大病保险工作有效缓解了农民"看病难、看病贵"问题,要完善好大病保险工作,需进一步提高统筹层次,加强政策宣传,推进合署办公,加强赔付监管。
Objective To sum up the experience of purchasing critical illness insurance under new rural cooperative medical system in Wuhan,to analyze the existing problems,and to provide the solutions.Results Program of critical illness insurance under new rural cooperative medical system was started up in Wuhan in 2014.By strengthening the fund management,regulating basic work,promoting the co- working,enhancing publicity and developing the insurance claims service,the work goes well.The ratio of participating farmers' actual hospital compensation increased significantly(P<0.01).The hospitalization compensation occupies the main part of fund expenditure.Fund overdraft was found in lesser populated area,but due to the municipal planning policies,the regional fund risk was prevented.Conclusions Purchasing critical illness insurance under New Rural Cooperative Medical System efficiently relieves the burden of medical costs on the farmers with serious illnesses.We need to raise the level of overall plan,enhance publicity,promoting coworking and strengthen the monitoring on insurance payment services.
Objective To sum up the experience of purchasing critical illness insurance under new rural cooperative medical system in Wuhan,to analyze the existing problems,and to provide the solutions.Results Program of critical illness insurance under new rural cooperative medical system was started up in Wuhan in 2014.By strengthening the fund management,regulating basic work,promoting the co- working,enhancing publicity and developing the insurance claims service,the work goes well.The ratio of participating farmers' actual hospital compensation increased significantly(P<0.01).The hospitalization compensation occupies the main part of fund expenditure.Fund overdraft was found in lesser populated area,but due to the municipal planning policies,the regional fund risk was prevented.Conclusions Purchasing critical illness insurance under New Rural Cooperative Medical System efficiently relieves the burden of medical costs on the farmers with serious illnesses.We need to raise the level of overall plan,enhance publicity,promoting coworking and strengthen the monitoring on insurance payment services.
引文
[1]国家发改委,卫生部,财政部,人力资源社会保障部,民政部,保监会.关于开展城乡居民大病保险工作的指导意见[Z].2012-08-24.
[2]陈秀芝,马安宁,盛红旗.新型农村合作医疗大病保险政策各方利益主体间的博弈分析[J].中国卫生经济,2014,33(1):63-65.
[3]陈磊.提升统筹层次是大趋势[J].中国社会保障,2009(5):23-24.
[4]方明旺,贾晓灿,常煜博,等.甘肃省新型农村合作医疗引入商业保险建立意外伤害保险的探析[J].中国卫生经济,2014,33(2):51-53.
[5]蔡亮,李丹.黑龙江省新型农村合作医疗大病保险:必要性与发展思路[J].东北农业大学学报(社会科学版),2014,12(2):26-31.
[6]于保荣,王涛,杨帆.商业保险公司参与新型农村合作医疗业务的原因分析:基于6区县的案例研究[J].中国卫生经济,2012,31(11):36-38.
[7]梁曦,梁宏沛.新型农村合作医疗试行商业保险模式的构建与推广途径[J].中国卫生经济,2014,33(4):49-52.
[8]马骋宇.新型农村合作医疗基金购买商业大病保险的博弈模型研究[J].中国卫生经济,2014,33(4):43-45.
[9]孙冬悦,孙纽云,房珊杉,等.大病医疗保障制度的国际经验及启示[J].中国卫生政策研究,2013,6(1):13-20.
[10]许丹.湖南省省市级医院新农合与医保即时结报模式比较[J].中国农村卫生事业管理,2011,31(4):333-334.
[2]陈秀芝,马安宁,盛红旗.新型农村合作医疗大病保险政策各方利益主体间的博弈分析[J].中国卫生经济,2014,33(1):63-65.
[3]陈磊.提升统筹层次是大趋势[J].中国社会保障,2009(5):23-24.
[4]方明旺,贾晓灿,常煜博,等.甘肃省新型农村合作医疗引入商业保险建立意外伤害保险的探析[J].中国卫生经济,2014,33(2):51-53.
[5]蔡亮,李丹.黑龙江省新型农村合作医疗大病保险:必要性与发展思路[J].东北农业大学学报(社会科学版),2014,12(2):26-31.
[6]于保荣,王涛,杨帆.商业保险公司参与新型农村合作医疗业务的原因分析:基于6区县的案例研究[J].中国卫生经济,2012,31(11):36-38.
[7]梁曦,梁宏沛.新型农村合作医疗试行商业保险模式的构建与推广途径[J].中国卫生经济,2014,33(4):49-52.
[8]马骋宇.新型农村合作医疗基金购买商业大病保险的博弈模型研究[J].中国卫生经济,2014,33(4):43-45.
[9]孙冬悦,孙纽云,房珊杉,等.大病医疗保障制度的国际经验及启示[J].中国卫生政策研究,2013,6(1):13-20.
[10]许丹.湖南省省市级医院新农合与医保即时结报模式比较[J].中国农村卫生事业管理,2011,31(4):333-334.