山西省新型农村合作医疗试点县农民疾病经济风险分析

【作者】 孙焱；

【导师】 郑建中；

【作者基本信息】 山西医科大学 ， 社会医学与卫生事业管理， 2005， 硕士

【摘要】 合作医疗理论认为合作医疗具有一定的抗疾病风险能力。在各地进行的合作医疗的实践中,提高合作医疗的抗疾病风险能力也被列入合作医疗目标之一。然而,如何衡量合作医疗抗疾病风险能力却未见研究报告。本文通过对合作医疗抗疾病风险能力的初步探讨,以期衡量和评价合作医疗抗疾病风险能力,为完善合作医疗的理论和实践提供依据。 新型农村合作医疗主要目的是抵抗疾病经济风险,特别是大病的经济风险。它的抗风险能力与筹资水平和家庭疾病经济风险有直接关系。本文基于全国新型农村合作医疗山西省试点县的基线调查数据,通过对不同经济水平农民疾病经济风险的分析,明确农民疾病经济风险的水平和新型农村合作医疗抗疾病经济风险的重点。由于遭受风险的个体其损失是以家庭为单位分担,因此,在衡量合作医疗抗风险能力时,本文将突破以往以个体为单位衡量疾病经济风险,而以家庭为单位进行衡量。 研究表明,随着家庭收入的增加,疾病经济风险逐渐降低。低收入人群疾病要严重,不得不承受较高的疾病经济负担。合作医疗的抗风险的重点在中低疾病风险人群,而对高风险人群的抗风险能力极其脆弱。换言之,调查地区的合作医疗还不能有效地阻断合作医疗参加者因病致贫的发生。 提高筹资水平可以提高合作医疗的抗风险能力。在设计合作医疗补偿方案时,确定门诊及住院“医和药”的补偿比例时,应从抗疾病经济风险角度出发,制定合理的起付线、补偿比、止付线、封顶线,使合作医疗的补偿向风险较大的疾病家庭转移。卫生服务机构提供成本较少而质量较高的服务,可起到间接提高合作医疗抗风险能力的作用。因病致贫是一个复杂的社会问题,从社会医学的观点出发,因贫致病,因病致贫是循环的过程,贫困是一果多因的现象。因此,还需要在合作医疗之外建立一种特困人口医疗救助制度,协同合作医疗共同解决因病致贫及因贫致病的问题。更多还原

【Abstract】 It is believed in theory that cooperative medical service is resistant to the disease risk to a certain degree.To enhance the capabilities of resistance to the disease risk is thought to be one of its purposes in practice.However,few researches have been conducted about how to measure the capabilities to resist risks.This report is supposed to measure and evaluate the resistance capabilities and to provide support for improving the theory and application of cooperative medical service through initiative researches into the resistance capabilities. The main purpose of new cooperative medical service in countryside is to resist disease economic risk,especially the economic risk of suffering major illness.The risk resistance capabilities and financing abilities are closely linked with family disease economic risks.Based on the datum collected in baseline survey of new cooperative medical service experimental county in Shanxi Province ,the report analyzed the disease economic risks of peasants at different economic levels and defined the levels of disease economic levels risks and the priorities of new cooperative medical service to resist the risks.This report measures the resistance capabilities in families instead of individuals as in the past,for the loss of individuals tends to be shared in families. Studies show that disease economic risk is diminished with the increase of family incomes.Lower income populations have to carry a much heavier disease economic burden when they suffer major illnesses.The risk resistance priorities is placed on the populations with a middle or low disease risk,and its resistance is extremely weak for the high risk populations.In another word,the cooperative medical service can not effectively prevent the occurrence of poverty in the participants resulted from disease. Better financing is able to enhance the risk resistance capabilities.When the compensation scheme is to be designed and the compensation ratio of consulting and hospitalization’s “treatment and medicine” is to be determined, reasonable minimum charge,compensation ratio and maximum charge should be make from the angle of resisting the disease economic risk,so that the compensation will be transferred to families with a higher risk.If the hygienic services can provide less costly quality service ,the contributions of cooperative medical services can be improved indirectly.Poverty caused by disease is a complicated problem.In social medicine,poverty causes disease,and disease causes more poverty,so the cycle goes,and the reaons for poverty are many.Therefore,a medical treatment aid system should also be established,and both are responsible for solving the problems of poverty and disease.更多还原