【作者】 石文伟；

【导师】 唐金成；

【作者基本信息】 广西大学 ， 金融学， 2007， 硕士

【摘要】 2002年中共中央、国务院在《关于进一步加强农村卫生工作的决定》中明确提出，在农村建立新型农村合作医疗。这是保障农民健康，统筹城乡经济社会协调发展，全面建设小康社会的重要举措。但是我们必须认识到，建立新型农村合作医疗制度是一项复杂的系统工程，政策性强、涉及面广、制约因素多，具体工作中会遇到许多困难和问题。为了进一步建立和完善新型农村合作医疗制度，研究如何解决新型农村合作医疗试点实施过程中遇到的问题，促进新型农村合作医疗的健康发展，就显得十分必要。近年来，保险公司积极地参与到新型农村合作医疗之中，取得了许多宝贵的经验。本文对保险公司参与新型农村合作医疗的两种典型模式——代理模式和保险合同模式进行了分析，提出保险公司参与新型农村合作医疗应当采用合同模式的观点。美国管理式医疗是一种比较成熟的保险合同模式，它对于控制医疗费用上涨，提高医疗质量都具有良好的作用。新型农村合作医疗基金实力弱小，面临着如何以最小的支出获得最大的医疗效果的问题。因此我国保险公司也应当采用管理式医疗的模式参与新型农村合作医疗。文章介绍了美国管理式医疗的运行机制，讨论了在新型农村合作医疗采用管理式医疗模式的可行性及具体步骤。更多还原

【Abstract】 In accordance with the Decision on Further Strengthening Rural HygieneWork issued in 2002, the CPC Central Committee and the State Council clearlyset forth a target for establishing the new rural cooperative medical care system,which is a major measure in the work to ensure the health of the farmers,coordinate the economic development in urban and rural areas and build amoderately prosperous society in all respects. However, we should be aware thatthe development of the new rural cooperative medical care system is acomplicated system work with the characteristics of strong policy guidance,deep influence and lots of restricted factors, and many difficulties and problemsremain on our way ahead. It’s therefore necessary to study how to solve theproblems arising from the implementation of the pilot plan of the new ruralcooperative medical care system in order to improve it.In recent years, commercial insurers have played an active role in the newrural cooperative medical care system and accumulated plenty of practicalexperience. On the basis of an analysis of the two typical modes, the agencymode and the entrusted mode, the author suggests that it is more suitable for thecommercial insurers to participate in the new rural cooperative medical care system by adopting the latter mode.The managed care in America is a mature entrusted mode that functionswell. in the control of medical expenses and in the improvement of medicaltreatments. The fund for the new rural cooperative medical care system is farfrom adequate, which results in the problem of the lowest expenses versus theutmost medical outcomes. The domestic commercial insurers should introducethe entrusted mode to get involved in the new rural cooperative medical caresystem. Following the operational mechanism of the managed care in America,the author probes into the feasibility and formulates specific methods for thecommercial insurers to participate in the new rural cooperative medical caresystem with the entrusted mode.更多还原