新型农村合作医疗健康体检的模式研究
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摘要
目的
本文旨在通过对新型农村合作医疗健康体检的内涵、利益相关主体、存在问题分析,以及四种不同健康体检模式的设计、实施效果和优缺点比较,探讨不同目的下适宜的健康体检模式,并提出相应的对策与建议,以促进新型农村合作医疗健康体检的持续发展。
方法
本文运用公共管理学、卫生事业管理学、卫生经济学、卫生统计学等理论和方法,通过理论分析、现场调查和人员访谈,对新型农村合作医疗健康体检的内涵、存在问题、利益相关主体、及不同目的下的适宜体检模式进行了分析。主要方法包括:(1)文献研究法;(2)现场调查法;(3)人员访谈法;(4)问卷调查;(5)卫生统计学方法。
结果
(1)新型农村合作医疗健康体检是指政府统一领导,卫生部门(主要是新型农村合作医疗管理部门)牵头,有关部门协作,以农民所在地的乡镇卫生院作为主要经办机构,为参合农民提供的健康体检。
(2)新型农村合作医疗的目的:①在合作医疗初期主要是扩大参合农民补偿受益面和缓解基金结余压力;②在合作医疗深入发展时期主要是通过疾病预防和健康教育对农民进行健康管理。
(3)新型农村合作医疗健康体检模式的主要内容:①体检的设计理念;②体检经费来源渠道与拨付标准;③体检经费拨付方式;④体检对象的界定;⑤体检项目的设置;⑥体检机构及医生的要求;⑦体检时间、地点安排及开展方式;⑧体检过程中的角色界定;⑨体检质量的监管与结果应用。
(4)新型农村合作医疗健康体检四种主要模式:①A模式:体检对象由“未获补偿”参合家庭推荐一人,“菜单式”检查项目设置,农民按需选择,从家庭账户基金中支付体检经费;②B模式:政府单列体检基金,体检标准分类设置,体检对象由“未补偿”参合居民调整到全体参合居民;③C模式:广覆盖面下的一般体格体检,从住院基金中支付体检基金;④D模式:针对性强的“两步走”体检,体检对象为“未获住院补偿”的参合农民,从合作医疗基金支付体检经费。
(5)新型农村合作医疗健康体检存在的主要问题:①体检设计理念不一致;②从合作医疗基金中提取体检基金的作法与合作医疗主旨及家庭账户补偿模式之间的矛盾;③体检对象确定现行健康体检政策之间的矛盾;④体检项目设置与有限经费和农民高期望值之间的矛盾;⑤部分地区体检资金使用效率低;⑥部分体检体检机构服务能力较低,医生水平有限;⑦体检政策宣传不到位,部分农民健康意识不高;⑧)体检标准不统一,组织方式与监管力度有待完善和加强;⑨体检结果应用不足。
结论
(1)明确政府(新型农村合作医疗管理部门为主)、体检机构(乡镇卫生院为主)、参合农民三方利益主体在健康体检过程中的责、权、利;(2)因地制宜,依据不同的体检目的设置相应的新型农村合作医疗健康体检模式。(3)从法律和政策上对农民健康体检予以明确,现行新型农村合作医疗健康体检的政策应保持一定时期内的稳定性;(4)新型农村合作医疗健康体检应逐步过渡到农村公共卫生范畴,由政府担当筹资责任主体,并整合农村地区不同领域的体检资源,以保证其发展的持续性;(5)建立相对统一的体检标准,以规范体检质量:(6)加强信息网络化技术在体检资料管理和分析中的应用;(7)建立健全新型农村合作医疗健康体检组织开展方式及监管体系;(8)加强乡镇卫生院服务能力建设,提高体检医生的水平。
Objective According to the analysis on connotation, stakeholders and problems of health examination in the New Cooperative Medical System(NCMS) and comparison of designing,effection, advantages and disadvantages among different models of health examination,the thesis discusses the appropriate models of health examination under different objectives,and raises reasonable countermeasures and proposals,which can promote health examination in the NCMS smoothly.
Methods Through theoretical analysis, field survey and interview,the connotation, stakeholders,problems and appropriate models under different objectives were analyzed by applying theories and methods of public management,health management,health economics,biostatistics and so on. The main methods include literature study, field survey, interview, questionnaire survey and biostatistics.
Results
1) Health examination in NCMS is provided for the farmers who have been in the NCMS for a period of time.It is under the unified leadership of government,and requests the health sectors to take the lead in collaboration with other related departments. Township hospitals are the main implementing agencies.
2) Objectives of health examination in NCMS:①In the beginning of NCMS,the main objective is to expand the compensation benefit of farmers joining in NCMS and ease pressure on the fund balances;②In-depth development of NCMS,the main objectivs is to manage farmers’health by disease prevention and health education.
3)Main contents of health examination in NCMS:①The designing of health examination;②Channel and payment of funds;③Methods of paying funds;④Defining the farmers of health examination;⑤Setting the items and contents of health examination;⑥Standards of township hospitals and doctors;⑦Arrangements of time,place and organization;⑧ Stakeholders’role in health examination;⑨Monitoring and using.
4) Typical models of health examination in NCMS:①A:Limited range of farmers and menu-set items;②B: Funds from Public health expenditure and different standards;③C:Wide coverage and simple examination;④D:Two-step and targeted examination.
5) Main problems of health examination in the NCMS:①Different concept of designing;②Funds of health examination from NCMS is questionable;③Methods of determining physical objects is questionable;④Contradictions among items,funds and farmers’expectations;⑤The use of funds is low efficiency in somg areas;⑥Service capacity of some towns hospitals is limited;⑦Policy advocacy and health awareness among farmers should be further strengthened;⑧Different standards is not conducive to control the quality;⑨The use of health examination is not enough.
Conclusion
1)Clear the duties,rights,and benefit among government, institutions and farmers;2) According to different objectives,appropriate models of health examination must meet with local conditions and the development of NCMS;3) The current policy of health examination in the NCMS should keep its stability and continuity for a certain period of time and be defined by law;4) For the further development,health examination in the NCMS should be integrated with other health examination in rural areas and put into the range of Public Health, in which government plays a dominant role;5)The uniform standards of health eaamination must be established to control guality;6)Healthy information should be collected, collated and used timely by building and applying the network and information technology;7) The organizations and monitoring system of health examination must be established and improved;8)Promte the quality of health examination by strengthening capacity-building and doctors’ability of township hospital. In this process,county-level medical institutions play a guiding role.
本文旨在通过对新型农村合作医疗健康体检的内涵、利益相关主体、存在问题分析,以及四种不同健康体检模式的设计、实施效果和优缺点比较,探讨不同目的下适宜的健康体检模式,并提出相应的对策与建议,以促进新型农村合作医疗健康体检的持续发展。
方法
本文运用公共管理学、卫生事业管理学、卫生经济学、卫生统计学等理论和方法,通过理论分析、现场调查和人员访谈,对新型农村合作医疗健康体检的内涵、存在问题、利益相关主体、及不同目的下的适宜体检模式进行了分析。主要方法包括:(1)文献研究法;(2)现场调查法;(3)人员访谈法;(4)问卷调查;(5)卫生统计学方法。
结果
(1)新型农村合作医疗健康体检是指政府统一领导,卫生部门(主要是新型农村合作医疗管理部门)牵头,有关部门协作,以农民所在地的乡镇卫生院作为主要经办机构,为参合农民提供的健康体检。
(2)新型农村合作医疗的目的:①在合作医疗初期主要是扩大参合农民补偿受益面和缓解基金结余压力;②在合作医疗深入发展时期主要是通过疾病预防和健康教育对农民进行健康管理。
(3)新型农村合作医疗健康体检模式的主要内容:①体检的设计理念;②体检经费来源渠道与拨付标准;③体检经费拨付方式;④体检对象的界定;⑤体检项目的设置;⑥体检机构及医生的要求;⑦体检时间、地点安排及开展方式;⑧体检过程中的角色界定;⑨体检质量的监管与结果应用。
(4)新型农村合作医疗健康体检四种主要模式:①A模式:体检对象由“未获补偿”参合家庭推荐一人,“菜单式”检查项目设置,农民按需选择,从家庭账户基金中支付体检经费;②B模式:政府单列体检基金,体检标准分类设置,体检对象由“未补偿”参合居民调整到全体参合居民;③C模式:广覆盖面下的一般体格体检,从住院基金中支付体检基金;④D模式:针对性强的“两步走”体检,体检对象为“未获住院补偿”的参合农民,从合作医疗基金支付体检经费。
(5)新型农村合作医疗健康体检存在的主要问题:①体检设计理念不一致;②从合作医疗基金中提取体检基金的作法与合作医疗主旨及家庭账户补偿模式之间的矛盾;③体检对象确定现行健康体检政策之间的矛盾;④体检项目设置与有限经费和农民高期望值之间的矛盾;⑤部分地区体检资金使用效率低;⑥部分体检体检机构服务能力较低,医生水平有限;⑦体检政策宣传不到位,部分农民健康意识不高;⑧)体检标准不统一,组织方式与监管力度有待完善和加强;⑨体检结果应用不足。
结论
(1)明确政府(新型农村合作医疗管理部门为主)、体检机构(乡镇卫生院为主)、参合农民三方利益主体在健康体检过程中的责、权、利;(2)因地制宜,依据不同的体检目的设置相应的新型农村合作医疗健康体检模式。(3)从法律和政策上对农民健康体检予以明确,现行新型农村合作医疗健康体检的政策应保持一定时期内的稳定性;(4)新型农村合作医疗健康体检应逐步过渡到农村公共卫生范畴,由政府担当筹资责任主体,并整合农村地区不同领域的体检资源,以保证其发展的持续性;(5)建立相对统一的体检标准,以规范体检质量:(6)加强信息网络化技术在体检资料管理和分析中的应用;(7)建立健全新型农村合作医疗健康体检组织开展方式及监管体系;(8)加强乡镇卫生院服务能力建设,提高体检医生的水平。
Objective According to the analysis on connotation, stakeholders and problems of health examination in the New Cooperative Medical System(NCMS) and comparison of designing,effection, advantages and disadvantages among different models of health examination,the thesis discusses the appropriate models of health examination under different objectives,and raises reasonable countermeasures and proposals,which can promote health examination in the NCMS smoothly.
Methods Through theoretical analysis, field survey and interview,the connotation, stakeholders,problems and appropriate models under different objectives were analyzed by applying theories and methods of public management,health management,health economics,biostatistics and so on. The main methods include literature study, field survey, interview, questionnaire survey and biostatistics.
Results
1) Health examination in NCMS is provided for the farmers who have been in the NCMS for a period of time.It is under the unified leadership of government,and requests the health sectors to take the lead in collaboration with other related departments. Township hospitals are the main implementing agencies.
2) Objectives of health examination in NCMS:①In the beginning of NCMS,the main objective is to expand the compensation benefit of farmers joining in NCMS and ease pressure on the fund balances;②In-depth development of NCMS,the main objectivs is to manage farmers’health by disease prevention and health education.
3)Main contents of health examination in NCMS:①The designing of health examination;②Channel and payment of funds;③Methods of paying funds;④Defining the farmers of health examination;⑤Setting the items and contents of health examination;⑥Standards of township hospitals and doctors;⑦Arrangements of time,place and organization;⑧ Stakeholders’role in health examination;⑨Monitoring and using.
4) Typical models of health examination in NCMS:①A:Limited range of farmers and menu-set items;②B: Funds from Public health expenditure and different standards;③C:Wide coverage and simple examination;④D:Two-step and targeted examination.
5) Main problems of health examination in the NCMS:①Different concept of designing;②Funds of health examination from NCMS is questionable;③Methods of determining physical objects is questionable;④Contradictions among items,funds and farmers’expectations;⑤The use of funds is low efficiency in somg areas;⑥Service capacity of some towns hospitals is limited;⑦Policy advocacy and health awareness among farmers should be further strengthened;⑧Different standards is not conducive to control the quality;⑨The use of health examination is not enough.
Conclusion
1)Clear the duties,rights,and benefit among government, institutions and farmers;2) According to different objectives,appropriate models of health examination must meet with local conditions and the development of NCMS;3) The current policy of health examination in the NCMS should keep its stability and continuity for a certain period of time and be defined by law;4) For the further development,health examination in the NCMS should be integrated with other health examination in rural areas and put into the range of Public Health, in which government plays a dominant role;5)The uniform standards of health eaamination must be established to control guality;6)Healthy information should be collected, collated and used timely by building and applying the network and information technology;7) The organizations and monitoring system of health examination must be established and improved;8)Promte the quality of health examination by strengthening capacity-building and doctors’ability of township hospital. In this process,county-level medical institutions play a guiding role.
引文
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