Issues concerning Migrant Workers' Participation in the New Rural Cooperative Medical System and Countermeasures——Based on the Survey in Wenjiang District and Jintang County, Chengdu City

We conduct questionnaire survey of migrant workers in Wenjiang District and Jintang County of Chengdu City,respectively,using the method of key-point investigation and the sampling survey. We describe the status quo of the sample migrant workers' participation in the New Rural Cooperative Medical System,analyze the issues concerning migrant workers' participation in the New Rural Cooperative Medical System,and put forward the countermeasures and recommendations as follows: using many types of medical insurance; establishing universal reimbursement points in strange land and premium-paying system for migrant workers; making the proportion of reimbursement open and transparent; establishing and improving medicare security system for migrant workers.

Restraining Factors and Improving Paths for the Operation Mechanism of New Rural Cooperative Medical System in China

The new rural cooperative medical system has achieved periodical achievements since its establishment.Nevertheless,there are many factors hampering the development of the new system,such as the high cost,the difficulties in fund procurement,the lack of management,the narrow coverage of benefit,the ineffective constraint to the designated medical institutions,the high fund balance rate,and the poor medical facilities and services in rural areas.Countermeasures are put forward to solve these problems,including improving the system design,expanding the coverage of the system,expanding the fund sources,reducing the financing costs,strengthening the fund supervision,enhancing the supervision of designated medical institutions,and improving the capacity of health services in rural areas.

On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

Government Responsibility in New Rural Cooperative Medical Care System from the Perspective of Equity and Efficiency

Equity and efficiency,as two essential parts of social security,always influence construction of China's new rural cooperative medical care system.The new rural cooperative medical care system is a rural social security system particularly intended to make it more affordable for the rural poor.It is a multi-channel fundraising system with fund of comprehensive arrangement for serious disease composed by the government,collectives and individuals.Since its implementation,it has made considerable achievements,but there are still many apparent and hidden problems.Through analyzing existing problems in the implementation of new rural cooperative medical care system,from the perspective of equity and efficiency,it reached the conclusion that government should take corresponding responsibilities.At the same time of constantly increasing efficiency,it is recommended to attach importance to the equity,so as to realize the objective of improving the security level of new rural cooperative medical care system.

The impact of the New Rural Cooperative Medical Scheme on the“health poverty alleviation”of rural households in China

This study investigates the impact of the New Rural Cooperative Medical Scheme(NRCMS)on rural households to escape poverty.We employ the instrumental variable method,the IVProbit model,to analyze the national data from the rural-resident field survey by the China Family Panel Studies(CFPS)in 2016.Based on the large-scale data,we found that,first,the hospitalization of family members is the key factor in increasing the risk of the family falling into poverty.The NRCMS has significantly reduced the likely risk of falling into poverty.Second,the impact of the NRCMS on poverty alleviation varies among groups with different levels of income.There is no impact on the upper-middle and high-income groups;in contrast,the NRCMS has substantially improved the capacity of low-income rural families to prevent poverty due to illness,especially for the lower-middle-income group.Third,there exist significant regional differences in the impact of NRCMS on the health poverty alleviation of rural households in China.The NRCMS has successfully reduced the risk of rural households in the western region falling into poverty,simultaneously,no significant impact on those in the eastern and central regions.In order to diminish and eliminate poverty eventually and boost rural residents'capacity for income acquisition,we propose the following:raise the actual compensation ratio of the NRCMS,control the rising expense of NRCMS by promoting the payment method reform,construct the comprehensive healthcare system in the western region,strengthen the medical security for the poor in remote area,and enhance the living environment for rural residents.

大病保险、医疗服务升级与农民健康

“健康中国2030”规划纲要明确了健康对经济社会发展的重要作用,在新型农村合作医疗制度未能显著改善农民健康的背景下,研究农民健康水平的提升机制具有重要意义。本文聚焦2012年8月开始试点实施的城乡居民大病保险制度,基于2011—2015年中国健康与养老追踪调查(CHARLS)数据,以样本所在城市是否试点实施农村大病保险作为依据构造“农村大病保险”参保变量,运用计量模型实证检验农村大病保险对农民健康的影响效应及机制。实证结果显示,试点农村大病保险使农民自评健康显著提高0.08个单位,并且在对健康水平和农村大病保险等变量进行重新调整的情形下,实证结果依然稳健。异质性分析结果显示,农村大病保险对低收入群体的健康促进作用更大,并且对社区内有医疗点的群体影响效果更为显著。机制分析结果显示,对于需住院群体而言,农村大病保险通过促进农民做出住院决策进而改善了健康;而对于住院群体,农村大病保险通过促进农民选择级别更高的县区级医院进而改善了健康。为进一步提高农民健康水平,应丰富农村大病保险的筹资主体,引入个人缴费和财政补贴,在扩大大病保险基金规模的前提下,进一步提升大病保险待遇水平;同时,应改善农村基层医疗资源分配,提高农民基层医疗服务可及性和服务水平。

乡村振兴视角下农民对新农合满意度影响因素研究——来自全国2152个农户的微观数据

人们对美好生活的向往是乡村振兴的关键衡量指标,农民对新农合满意度评价影响到农民对于乡村振兴建设的满意度。本文关注乡村振兴视角下,农民对新农合满意度影响因素,利用全国2152个农户入户调查数据,采用Eveiws软件对数据进行了有序Logistic回归分析,结果表明:整体上农民对新农合满意度高于不满意度比例,55%对新农合表示满意,37%则对新农合持有一般态度;年龄、文化程度、农民纯收入对新农合满意度具有显著正向作用,说明提升文化程度以及改善人民收入,有利于提升新农合满意度;通过网络获取医疗信息便利度对新农合满意度有显著正向影响,表明互联网的使用,强化了农民信息获取、便利了农民之间的交流,从而带动了人们对农村新农合的满意度;比照东北区域村庄,东部区域和中部区域村庄居民对新农合满意度要低一些。

陕西省新农合单病种定额付费改革的效果分析——基于镇安和旬邑两县的抽样调查

目的:实证分析陕西省单病种定额付费改革的实施效果。方法:选择陕西省镇安和旬邑两县作为研究对象。资料主要包括两县2008—2011年的新农合报表;同时对两县164名县级医院医务人员进行调查,了解他们对单病种定额付费的认知。定性资料主要采用焦点组访谈和个人深入访谈的方法,共访谈32人。利用SPSS13.0和EXCEL2007等软件进行数据分析。结果:单病种定额付费改革后医疗机构次均住院费用增速减缓,对医疗服务质量的影响尚不确定,对医务人员的满意度产生一定影响,提高了参合农民住院医疗服务的可及性,有助于引导患者合理就医,促进卫生资源有效利用;实施单病种定额付费患者的疾病负担缓解程度更加明显,也有助于降低新农合基金的风险。建议:科学制定支付标准,为顺利实施单病种定额付费改革奠定基础;建立健全针对供方的有效激励约束机制;加强单病种定额付费对医疗服务质量影响的研究和对定点医疗机构的监管。

农民参与新型农村合作医疗及满意度分析--基于3省245户农户的调查

调查数据表明,农民的新型农村合作医疗参合率高达93.33%。logistic模型实证发现,与周围的人大多不参与新农合的受访者相比,周围的人大多参与新农合的受访者的新农合参与率要高出314倍。通过其他方式宣传而参与的农户要低68%。高收入者参与新型农村合作医疗的可能性要高3.45倍。有90.3%的参合者对新型农村合作医疗制度总体表示满意,农民对各级医疗机构服务的满意程度均超过80%,但仍存在着新农合制度保障水平偏低以及基层卫生医疗服务在技术、态度、收费等方面不能满足农民需求等问题。

“新农合”改善农村居民的身心健康了吗?——来自苏鲁皖豫四省的经验证据

农民参与新农合的积极性不断提高,但学者们关于新农合对农民健康状况的改善效果存在较大分歧。本文基于马斯洛需求层次理论,通过对苏鲁皖豫四省的795份农户调查数据实证分析,厘清了新农合对农民身心健康的影响机理,并对改善农民身心健康的影响因素进行分析。结果显示,新农合促进了农民身心健康的改善;农民对新农合的参与积极性和治疗满意度较高;参加新农合时长、家庭是否有大病报销对参合者身心健康改善的具有正向影响,而超过门诊补贴上限则具有负向影响。根据上述结论,提出了健全报销比例调整机制、提高对弱势群体的支持力度、平衡城乡医药资源配置等政策建议。

新型农村合作医疗供方支付方式的利益相关者分析

运用利益相关者理论,分析主要供方支付方式在新农合制度中,对经办机构、供方和需方三方主要利益相关者的各种利益影响,认为单一支付方式无法满足三方多层面的利益诉求,唯有采用混合支付方式的形式,融合各支付方式的优点,才能平衡三方利益,维持新农合的制度均衡,促进新农合制度的可持续发展。通过理论分析,提出将按项目付费、按病种定额付费和总额预付制相融合的混合支付方式,是目前适合新型农村合作医疗的利益均衡支付方式。然而,这种支付方式与实际应用之间还有一定距离,还需要理论和操作上若干研究支持。

成都市温江区新型农村合作医疗参合农民满意度调查

目的选点抽样调查参合农民对新型农村合作医疗(新农合)的满意度,分析影响满意度的因素,为我国特别是成都地区优化和改进新农合实施方案提供决策参考。方法计算机单纯随机抽取温江区3个乡镇作为调查对象,采用走村入户与农民面对面访谈的方式随机对温江5％参合农户户主用自制问卷调查表进行调查。分别采用Epidata 3．0和ISPSS 11．5软件进行数据录入和统计分析。结果共发放问卷2 500份,收回有效问卷2 438份(有效率97．56％)。58．1％的农户对新农合总体满意,逐步logistic多元回归分析发现,参合意愿(自愿、随大流、其他)(偏回归系数B=-3．54,P=0．014)与对现有报销比例的满意度(偏回归系数B=-4．62,P=0．018)是影响参合农民对新农合总体满意度的最重要因素。结论加大新农合宣传力度,合理设定补偿方式及比例,提高农民自愿参合率及参合农民受益度,对于提高新农合质量和绩效具有重要作用。

医保支付之限额付费方式——基于湖南蓝山、桑植两县的调查

医疗保险支付方式是医疗保险机构对医、患(参保人)的付费方式。支付方式改革是当今世界很多国家医改的核心与难题。湖南蓝山县和桑植县推行了限额付费方式改革,参合农民在乡镇卫生院看病就医,门诊、住院费用付费限额内如实自付,超额部分由新农合基金全额报销,同时,对卫生院实行诊疗人次费用、住院床日费用以及总费用控制,对医生实行绩效工资制。创造了有别于"全民免费医疗"的"全民限费医疗"新模式。推广这种新模式的路径是:明确医疗服务的享受主体、服务主体及范围,科学制定总额预付标准,完善监管机制,建立医疗服务与社会医疗保险二位一体的新体制等。

湖北省新型农村合作医疗试点县农民疾病经济风险分析

通过对疾病家庭的疾病经济风险、特定人群疾病经济风险、超过致贫线住院家庭相对疾病经济风险的分析显示低收入农民疾病经济风险是高收入家庭的3.09倍;大部分家庭都处于低疾病经济风险中,但15.09%的家庭疾病经济风险较高;县和县级以上医院住院家庭疾病经济风险分别是乡镇卫生院住院家庭的2.40倍和6.20倍。提出在新型农村合作医疗方案设计中需考虑低收入家庭疾病经济风险分担、合理引导卫生服务利用、保障力度和受益面的矛盾等问题。

安徽省肥西县新型农村合作医疗研究(二)——农村居民住院医疗费用负担调查与分析

分析了肥西县农村居民住院医疗费用总体负担水平、住院医疗费用负担机构分布情况和不同社会特征人群的住院医疗费用负担情况,以及住院间接费用负担水平。并得出:肥西县农村居民住院医疗费用负担较重,特别是人均纯收入较低人群;不同医疗单位住院费用差异显著,县外医院住院费用比例过高;不同特征人群的住院医疗费用负担不均衡。

新型农村合作医疗混合支付方式的博弈模型研究

利用博弈论基本概念和不完全信息动态模型,构建新农合经办机构与医疗机构之间关于费用控制的博弈模型,并利用博弈树,分析得到模型的均衡解,即经办机构选择预付制与后付制相结合的混合支付方式,才能使医疗机构有动力控制医药费用,并为新农合制度带来利益均衡,维持其可持续发展。但混合支付方式的具体表现形式需要通过委托-代理模型进行进一步论证。