商业保险机构参与新农合经办的条件与对策——基于6个典型地区的调研.pdfVIP

Chinese }ournal of Health Policy , May 2013 •Vol. 6 No儿 5 ·医疗保障· 商业保险机构参与新农合经办的条件与对策 一一-基于 6 个典型地区的调研 高广颖擎常文虎韩优莉李丹马骋字吴妮娜李颖 首都医科大学卫生管理与教育学院 北京 l ∞069 【摘 要】目的:通过分析商业保险机构参与新农合经办的效果，为商业保险机构介入新农合管理提出对 策和建议。方法:选择新乡、江阴等商业保险机构参与新农合经办业务的六个市区进行现场调研，并与全国同 期新农合运行指标进行了对比分析。结果:商业保险机构运行以来，新农合参合率不断提高，农民受益幅度得 到提升，医疗费用得到了拉制，农村卫生服务体系得到发展;但同时存在管理费到位滞后、人员不稳定、监管不 到位等问题。结论:当基金超支严重、管理能力不足、信息系统不健全时，适宜引入商业保险机构经办新农合 业务。商业保险机构更适合于大病补偿保险、新农合补充保险等业务。政府要通过招标方式选择保险公司， 并对保险公司进行有效监管。 【关键词】新型农村合作医疗;商业医疗保险;经办模式 中图分类号:R197.1 丈献标识码:A doi: 10. 3969/j. issn. 1674-2982.2013.05.008 The condition and countermeasure on the commercial insurance companies participation for the New Rural Cooperative Medical Scheme: ßased on the survey in six cities and counties GAο Guang训ng. CHANG Wen扣l ， HAN You-li , Li-dan , MA Cheng-归， WU Ni-na , LI Ying School 0/ Health Management and Educαtion ， Capital Medical University , Beijing 100069 , China [Abstract] Objectives: In this paper , we analyze the effectiveness of commercial insurance model for the New Rural Cooperative Medical Scheme (NRCMS). We a1so ana1yze prob1ems with the morle1 and explore countermeas- ures. Methods: We conducted a field survey in six cities and counties , including Xinxiang and Jiangyin , where com- mercial insurance companies participated in the NRCMS. We compared the results with a nationwide performance in- dex of the NRCMS over the same period. Results: 币le invo1vement of commercial insurance companies in the NRCMS has meant that participation in the NRCMS has increased , farmers have gained more , medical costs have been con- trolled , and the rural health service system has developed. Some problems that need addressing include delay of man- agement expenses and unsteady insurance compan