【作者】 徐立柱；

【导师】 李士雪；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2007， 硕士

【摘要】 新型农村合作医疗制度是政府组织、引导、支持，农民自愿参加，个人、集体和政府多方筹资，以大病统筹为主的农民医疗互助共济制度。其目的是通过互助共济，共同抵御疾病风险，减轻农民因病带来的经济负担，缓解因病致贫、因病返贫状况。新型农村合作医疗制度的普遍特点是提供同时覆盖基本门诊和大病住院服务的单一福利包，达到了“低水平、广覆盖”的目的。但是，较低的保费覆盖广泛的服务结果，必然导致农民利用服务时的高共付率；另一方面，各地新农合补偿方案中，普遍设立补偿起付线，同时随着医疗费用的增加，规定了逾高的补偿比例。收入较高的参合农民一般身体状况较好，但因其有较强的费用支付能力，可以更多的利用卫生服务；贫困农民健康状况较差，但因其较低的支付能力，无法达到合作医疗的起付线进入补偿范围，也无法承担较高的共付费用，服务利用较少。这就可能使得贫困农民在支付了同样的参合费用的情况下，较富裕农民，从合作医疗基金里获得了更少的补偿，健康状况更差却利用了更少的卫生服务资源，在筹资水平一样的情况下合作医疗基金可能发生了转移，出现了一种穷人补贴富裕者的现象。本课题的主要目的是通过科学的调查与论证，研究在当前新型农村合作医疗制度下，各地区经济水平、基金补偿农户的家庭经济状况、获得补偿费用、医疗费用负担情况等信息，以此掌握合作医疗基金的使用流向，发现不同经济水平地区和农户获得补偿机率、获得补偿费用的差异，研究不同收入地区和农民在现行合作医疗制度下费用负担的公平性，探讨贫困参合农民受益不公的程度、来源与表现方式，提出改善合作医疗公平性和加强贫困农民医疗保障的具体措施与方法，为以后政策的制定提供依据，在新型合作医疗制度下，为贫困农民提供更好的医疗保障。通过研究，发现：1、在曲阜以村为单位的受益公平性分析中，不同经济水平地区参合农民获得补偿的机率有很明显的差异，门诊与住院集中指数分别为0.054和0.056；以全部参合农民来看，补偿费用的分布也不公平，其流向更加倾向于富裕地区，住院补偿费用集中指数为0.047；如果仅仅以获得补偿的参合农民为分析对象，总的补偿费用在参合农民中的分布是更加集中在较富裕地区，集中指数为0.049。2、曲阜获得医疗费用补偿的参合农民获得补偿费用并未显示出明显的贫富差异，补偿费用更加集中于低收入人群，对较贫穷农户相对更加有利，集中指数为-0.025。3、嘉祥农民个人受益显示出较明显的贫富差异，补偿费用更多集中于高收入人群，集中曲线向下倾斜，集中指数为0.114。更多还原

【Abstract】 The new rural cooperative medical scheme (NCMS) is the medical mutual redress scheme for rural people, which is organized, guided and supported by the government, participated voluntarily by rural residents, funded by multiple parties including the individual, the collective and the government, focused on compensating catastrophic diseases. The objective of it is to reduce the burden of medical expenses of rural people and relieve the poverty for disease, according to mutual redress. The character of NCMS is to provide the single welfare package covering the outpatient and inpatient service and achieve the "low level, extensive coverage". However, the outcome of low premiums and extensive coverage is high co-payments in the rural residents’ health services utilization. On the other side, in the reimbursement projects of many places, cost sharing ration is established. And with the increase of the medical expenses, the proportion of reimbursement is higher. The rich peasants are healthy, but have the stronger payment capability and more services utilization. The less income peasants’ health conditions are poor, but they can’t enter the scope of reimbursement of NCMS and afford the high co-payments, because of their weak payment capability. This induces that poor peasants may get less reimbursement from the foundation of NCMS and services utilization than the rich ones, under the situation that paying the equal premiums. So there exists a transfer of foundation of NCMS. The aim of the thesis is to maker a research about the economic levels, the living conditions of the families getting the reimbursements, the reimbursements and the medical expenses under NCMS, and to find the allocation of the NCMS foundation, according to scientific investigations and argumentations. And to discuss the equity of medical expenses burden between different income places and peasants and to probe into the degree, source and expressive form of benefit inequity. And to advance measures to improve the equity of NCMS, strength the medical security of the poor peasants and to give some suggestions for policy making.According to the research, it is found that:1、In the village analysis of benefit equity in Qufu, peasants in different economic level places have much difference on the possibility of getting reimbursements. The concentration indexes of outpatient and inpatient are 0.054 and 0.056. Seeing from all the peasants participating in the NCMS, the allocation of reimbursement fund is inequitable and is good for the rich area. The concentration index of reimbursement fund of inpatient is 0.047. Seeing from the peasants getting the reimbursement, the concentration index of reimbursement fund of inpatient is 0.049.2、In the analysis of the peasants getting the reimbursement in Qufu, there doesn’t exist much difference on the benefit between the poor and the rich. The reimbursement fund is more concentrated on the poor and the allocation is good for the poor. The concentration index is -0.025.3、In the analysis of the peasants getting the reimbursement in Jiaxiang, there exists much difference on the benefit between the poor and the rich. The reimbursement fund is more concentrated on the rich and the allocation is good for the rich. The concentration index is 0.114.更多还原