【作者】 王红；

【导师】 杨兴洪；

【作者基本信息】 贵州大学 ， 农林经济管理， 2019， 硕士

【摘要】 新型农村合作医疗制度作为一项造福人民的健康医疗保险制度,旨在保障农村居民的身体健康,解决农民“看病难、看病贵”的问题。新农合政策实施以来,其补偿制度、双向转诊制度等发挥了积极的作用,使农村居民选择基层医疗机构就诊的比例有所增加。但是,随着人民物质文化需求的不断提高和市场经济的快速发展,居民对医疗服务需求不降反增。但一些乡村还相对比较落后,基层医疗服务难以满足农村居民的生活需要,使得农村居民大量涌入大医院进行就诊,无形中增加了农村居民和大医院的负担,且医疗费用的上涨也会影响新农合的可持续运作。因此,量化新农合对农村居民就医行为的影响程度,对于完善新农合制度,形成合理的就医格局具有重大的意义。本文采用国际粮食政策研究所(IFPRI)、中国农业科学院和贵州大学共同组织的,关于2006年、2009年、2011年和2017年对贵州省普定县3个行政村开展的四轮跟踪调查数据,利用Heckman样本选择模型和多项Logit模型研究调查区域农村居民就医行为及就医流向情况。研究结果表明,新农合政策的实施可以促使农村居民患病就诊的概率提高65.5%,在就医流向上倾向于向县级医院就诊,却减少前往村卫生所就诊的可能性,其中,参合患者选择县医院就诊的概率是选择村卫生所的6.75倍。究其原因主要是由于当前研究区农村医疗基础设施匮乏、医疗设备老化、医务技术人员缺失及医疗环境较差等以及政策实施过程中存在偏差所致,使得大医院人满为患,加大医院的就诊压力,小医院却门可罗雀,难以发挥其作用。此外,疾病的严重程度、个人纯收入和个人特征等也是影响农村居民就医的重要因素。基于上述研究结论,从改善农村基层医疗服务体系和优化新农合政策的实施情况的角度出发,论文提出以下几点建议:第一,要完善基层卫生服务体系,健全农村三级卫生服务网络,形成功能互补和转诊协调的就诊机制。实现参合农民“小病不离村、普通病不离乡、大病不离县、重病和疑难疾病进入县级以上医疗机构”的就医格局;第二,完善新农合相关政策,有效利用医疗资源,形成“小病在乡镇、大病去医院、康复回乡镇”的就医模式,进而有效合理地利用医疗资源;第三,加大新农合制度的理性宣传,引导居民理性就医,为农村居民普及就医及卫生常识,改变农村居民不合理的就医观念;第四,完善医务人员薪酬制度,防止医疗服务的道德风险,这不但可以减少过甚的医疗消费,还能稳定基层医务人员,防止人才流失;最后,提高农村居民的医疗健康意识,发展农村健康宜居的生活环境,为农村居民的卫生健康奠定良好的基础。更多还原

【Abstract】 As a health insurance system for the benefit of the people,the new rural cooperative medical system aims to protect the health of rural residents and solve the problem of “difficult to see a doctor 、 expensive to see a doctor”.Since the implementation of the NRCMS policy,its compensation system and two-way referral system have played an active role,increasing the proportion of rural residents choosing primary health care institutions.However,with the increasing material and cultural needs of the people and the rapid development of the market economy,and the demand for medical services is increasing.But some villages are still relatively backward,grassroots medical services are difficult to meet the living needs of rural residents,causing a large influx of rural residents into large hospitals for treatment,which inevitably increases the burden on rural residents and large hospitals,and the increase in medical expenses will also affect the sustainable operation of NCMS.Therefore,quantifying the degree of influence of the new rural cooperative medical system on the medical treatment behavior of rural residents is of great significance to the improvement of the new rural cooperative medical system and the formation of a reasonable medical treatment pattern.This paper uses the International Food Policy Research Institute(IFPRI),the Chinese Academy of Agricultural Sciences and Guizhou University to organize four rounds of survey data for the three administrative villages of Puding County,Guizhou Province in 2006,2009,2011 and2017.Using Heckman sample selection model and multiple Logit models to study the medical behavior and medical treatment of rural residents in the survey area.The results of the study show that the implementation of the new rural cooperative medical policy can increase the probability of rural residents suffering from disease treatment by 65.5%,and tend to go to the county hospital for medical treatment,and reduce the probability of going to the village health clinic.The probability of choosing a county hospital is 6.75 times that of a village health clinic.The reason is mainly due to the current lack of rural medical infrastructure,the aging of medical equipment,the lack ofmedical technicians and the poor medical environment,as well as deviations in the implementation of policies,making large hospitals overcrowded and increasing the pressure on hospitals.The small hospital is so close that it is difficult to play its role.In addition,the severity of the disease,personal net income,and personal characteristics are also important factors affecting rural residents’ medical treatment.Based on the above research conclusions,from the perspective of improving the rural primary medical service system and optimizing the implementation of the new rural cooperative medical policy,the paper puts forward the following suggestions: Firstly,it is necessary to improve the primary health service system,improve the rural three-level health service network,and form a mechanism for functional complementarity and referral coordination.To achieve the medical treatment pattern of “small diseases that do not leave the village,ordinary diseases do not leave the country,major illnesses do not leave the county,serious illnesses and difficult diseases into the medical institutions at or above the county level”;Secondly,improve the relevant policies of the new rural cooperative medical system,effectively use medical resources to form “small The disease is in the township,the disease goes to the hospital,and the health care returns to the township”,so as to realize the effective and rational use of medical resources.Thirdly,increase the publicity of the new rural cooperative medical system,guide the residents to seek medical treatment reasonably,and increase the common sense of rural residents.Change the unreasonable concept of medical treatment for rural residents;Fourthly,improve the medical staff compensation system and prevent the moral hazard of medical services,not only can reduce excessive medical consumption,but also stabilize the grassroots hospital personnel to prevent their loss;Finally,improve the health awareness of rural residents,develop a healthy and livable life in rural areas,and lay a good foundation for the health and well-being of rural residents.更多还原