新农合的运行困境与优化路径--来自湖南省D县的证据

基于湖南省D县的调查,在对D县新农合运行现状分析的基础上,总结D县新农合运行存在的问题与原因,并提出具体优化路径。研究发现,D县新农合农民参合率逐年上升,制度保障性不断增强,农民就医选择权不断扩大,运行管理日趋严格;但仍存在农民受益水平低、实际保障基准有限、实际享受的优质医疗资源少以及农民受惠水平不均等关键问题;缺乏对定点医疗机构监管、农民医疗费用分担能力弱、医生道德风险制约新农合发展以及医疗费用增长过快以致资源配置失衡是导致这些问题的主要原因。为最大限度发挥新农合对缓解农民因病致贫、返贫的作用,应从理顺贫困群体医保管理机制、提高农民医疗费用分担能力、严格医生考核制度以及优化医疗资源配置四方面优化现有新农合,以促进新农合的进一步发展。

On the Dilemma and Optimized Path of New Rural Cooperative Medical System:Evidence from D County,Hunan Province

Based on the investigation and analysis of the operation status of new rural cooperative medical system(NCMS) in Hunan Province and the analysis of, this paper summarizes its problems and corresponding causes and puts forward the specific optimizing paths. The study finds that the participation rate of NCMS in D county is increasing annually, the institutional guarantee is increasing, the farmers’ right to seek medical treatment is expanding, and the operation and management are becoming more stringent. However, there are still some key problems, such as low level of farmers’ benefits, limited practical support standards, insufficient highquality medical resources that are actually enjoyed, and unequal levels of farmers’ benefits. Factors like the lack of supervision on designated medical institutions, farmers’ inadequate ability to share medical costs, the doctors’ moral standards which restrain the development of NCMS, the rapid growth of medical expenses leading to the imbalanced resource allocation are the main causes of these problems. We should optimize the existing NCMS from the following four aspects: straightening the medical insurance management mechanism for poor groups, improving the sharing ability of the farmers’ medical expenses, strictly assessing the doctors’ qualification and optimizing the allocation of medical resources, so as to save farmers from poverty and promote the development of NCMS.