农村税费改革后合作医疗筹资可持续性研究

税费改革是党中央、国务院完善农村市场经济体制的一项重大举措，其实质是对农村利益分配政策的一次全面调整，也必然牵涉到农村卫生事业和农民医疗保障制度的筹资问题。本文将分析当前农村合作医疗筹资存在的挑战，探讨农村税费改革后如何保证合作医疗筹资的可持续性。     

浙江省农村卫生改革探讨

指出农村卫生工作存在的主要问题：合作医疗制度重建及医疗保健等筹资困难;卫生服务利用不足,农民基本医疗需求难以保障;政策措施落实不力,资金投入不足;管理体制不顺等。提出应转变观念,优化布局,调整功能;推进农村医疗机构产权制度改革;增加对农村卫生事业的投入,实施相关政策;充分合理利用城市医疗卫生资源以及建立和完善农村医疗保障体系。     

宁波市新型农村合作医疗制度设计研究

新型农村合作医疗的制度设计应突出体现其新型性、科学性和合理性。核心是克服传统农村合作医疗弱点，建立可持续发展机制。遵循统一规划，因地制宜；农民自愿，政府推动；多方筹资，科学管理；以收定支，保障适度的基本原则。同步推进农民大病统筹、医疗救助和农村社区卫生服务三大体系建设。最终建立与社会经济发展相适应的农民基本医疗保障制度，实现构筑城乡一体化的社会医疗保障体系。     

发展和完善农村合作医疗保健制度 加快建立我市社会医疗保障体系──安阳市农村合作医疗工作调查报告

发展和完善农村合作医疗保健制度加快建立我市社会医疗保障体系──安阳市农村合作医疗工作调查报告河南省安阳市卫生局（４５５０００）杨洲，路常东，王民宪，刘友山合作医疗保健制度是指在政府领导和集体经济扶持下，以农村居民为对象，通过国家、集体和个人共同筹资沙...     

岳西、镇安两贫困县新型农村合作医疗筹资研究

通过对岳西和镇安2个贫困县新型农村合作医疗筹资现状进行调查研究,发现2县存在筹资水平偏低,地方财政筹资责任难落实,贫困、准贫困及流动人口筹资困难,农民风险共济意识缺失与对新型农村合作医疗期望过高共存,“自愿原则”下筹资难度大、成本高和集体经济扶持缺失等问题。提出:继续保持对解决“三农问题”有利的政治环境,保持政策的稳定性;建立完善的包括解决贫困人口筹资问题在内的医疗救助制度;加大中央、省、市级政府的资金扶持力度;创新新型农村合作医疗筹资方式,坚持“自愿原则”;调整现行的筹资顺序,建立顺应农民心理的筹资机制;积极扩展筹资渠道,提高筹资水平;农村人口流入地与流出地密切协调,在更高层次研究解决流动农民人口的医疗保障问题;控制医药费用的不合理增长,提供适度医疗保障,增进基金的安全,提高资金的使用效率。     

新型农村合作医疗个人筹资的实践与思考

建立新型农村合作医疗制度的关键是建立一个稳定持久、逐年增大的农民自愿筹资机制，其工作的难点在于资金的筹集。农民个人参保金的筹集到位情况和农民继续参加合作医疗意愿情况也是检验合作医疗工作成效的重要指标之一。但是迄今为止．农村合作医疗仍未形成合理有效、持久稳定的筹资机制。尤其是在一定筹资水平标准下提高农户自愿筹资率、扩大筹资覆盖面方面仍举步维艰。     

加快建立新型农村合作医疗长效机制问题探讨

建立和完善新型农村合作医疗长效机制是新型农村合作医疗制度长效运行并充分发挥医疗保障作用的重要保证。建立新型农村合作医疗长效机制，必须科学界定统筹对象、内容和层次，建立和完善长效筹资机制、长效运行机制、长效监管机制，进一步深化农村医疗卫生管理体制改革，加大农村医疗卫生事业投入，尽快建立和完善农村医疗卫生服务体系。     

加强农村合作医疗管理 提高农民医疗保障水平

农村合作医疗是当前我国农村居民的主要医疗保障，也是农村社会保障体系的重要组成部分。巩固和发展农村合作医疗对提高农民健康水平，促进农村经济发展，维护农村社会稳定具有重大意义。多年来，我区的农村合作医疗和农民就医问题在区委、区政府的领导和关心下，不断发展和改善。区委、区政府要求把完善农村合作医疗工作、改善农民就医问题作为当前解决农民问题的重要内容，并将农民的社会保障、农村合作医疗制度及农民就医问题列为重点调研和重点推进工作。     

日韩两国农村医疗保障制度对我国新型农村合作医疗制度的启示

随着我国社会经济的发展和医药卫生体制的改革,加快完善农村医疗保障制度的建设具有重要的现实和长远意义.通过比较研究日、韩两国的医疗保障制度在法律保障、农民与其他人群统一与否、筹资及补偿等方面的特征,得出对我国新型农村合作医疗制度的启示:(1)继续实行分层次的医疗保障制度,最终实现城乡一体化.(2)尽快建立起完善有效的法律保障制度.(3)积极探索多种筹资方式,提高保障能力.(4)建立农民互助组织,分担医疗保障制度外的医疗风险.     

宁波市新型农村合作医疗制度实施进展报告

宁波市新型农村合作医疗制度的目标是同步推进农民大病统筹、医疗救助和农村社区卫生服务三大体系建设，最终建立与社会经济发展相适应的农民基本医疗保障制度，实现构筑城乡一体化的社会医疗保障体系。通过1年多来的实践，全市县(市)区已全面推开，初步建立了新农医制度的良性运行机制，创造性地发展了新农医的多种运作模式，构建了农村基本医疗保障雏形，农民群众对制度的满意率达到了93．1％。     

对两县90年代合作医疗兴衰的分析

对山西省两县90年代合作医疗兴衰原因分析表明，单纯依靠政府一时性的政策鼓励和行政手段不利于合作医疗的长期稳定发展。农村合作医疗与其他保障制度一样也是一项庞大的系统工程，需要有方方面面的条件支持：政府有关部门间政策的协调是建立合作医疗的保证；所定政策具体、组织管理机构明确是合作医疗长期大范围在农村运行的基础；增加现有补偿水平和受益面是合作医疗的动力；提高农民和基层干部的积极性是维护合作医疗的关健。而现阶段，在上述条件短期内无法改善的情况下，选择一种过渡方式以缓和类似农村地区医疗保障需求的巨大压力是当务之急。     

我国农村合作医疗需求的经济学分析

合作医疗是我国农村医疗保障制度的主要形式，它的发展既有政府的作用，也离不开农民群众需求的作用。文章分为三个部分，一是分析合作医疗需求与农村卫生服务需求的关系，二是通过保险学原理分析合作医疗需求问题，最后分析合作医疗的政策重点。     

制定农村大病统筹医疗保险方案的操作步骤

针对县（市）一级农村医保政策制定者的迫切需要。在关键技术的研制和模拟使用基础上，提供一整套旨在解决农村因病致贫问题的农村医疗保险或合作医疗方案的损伤步骤。共包括下列６个逻辑上相连的操作步骤；基线调查，划分特殊人群与描述人群就医概况。就医经济风险测量，界定就医风险临界线，测算保险费率及方案选择和评估。     

Rural‐urban disparity in risk exposure to involuntary social health insurance transition in China: An investigation of chronic disease patients' mental health problems

Chronic disease patients have long suffered from mental health problems because of the long‐lasting and costly treatments. Although the multilevel social health insurance system in China attempts to provide them with full‐fledged health insurance coverage, the increasing prevalence of gig economy unexpectedly disrupts this situation. As the social health insurance system in China is closely associated with employment status, unemployed rural‐to‐urban migrant workers/regular urban workers have to accept the transition from urban employee basic medical insurance (UEBMI) to new cooperative medical scheme (NCMS)/urban resident basic medical insurance (URBMI). This study investigates the influence of this involuntary health insurance transition on the mental health of chronic disease patients. Empirical results show that the experience of transition from UEBMI to NCMS would significantly deteriorate the mental health of chronic disease patients, while the transition from UEBMI to URBMI would not. Accordingly, chronically ill rural‐to‐urban migrant workers are vulnerable to the involuntary health insurance transition that further deteriorates their mental health, and the multilevel social health insurance system in China cannot cope well with the emerging phenomenon of frequent employment change in labor market.     

从费用控制角度谈新农合可持续发展

费用控制对新农合的可持续发展起着关键作用。文章从医疗服务的需方、供给方和合作医疗经办机构三方面谈费用控制不当阻碍新农合可持续发展的因素，探讨解决的办法，提出措施：提高农村基层医疗机构的服务能力；规范定点医疗机构的医疗行为；改变新农合费用支付方式；规范患者不合理就医；加强立法与监管，完善农村医疗保障体系。     

湖北省新农合即时结报现状及应对策略

新农合定点医疗机构即时结报(即新农合"直补")已经成为新农合乃至整个医疗保险行业发展的必然趋势。文章介绍了湖北省新农合"直补"的现状,分析了在"直补"政策的宣传落实、制度管理及操作规范、网络结算方式等方面出现的问题,并针对性提出了加强宣传和指导落实"直补"政策;完善新农合"直补"信息管理及实行一人一卡制度;统一实现省级平台"直补"结算,提高效率,减少纠纷等具体建议,期望能对进一步完善新农合"直补"工作有所裨益。     

日本重大疾病保障制度经验借鉴及启示

借鉴日本的经验,结合我国重大疾病保障制度实施现状,为我国重大疾病保障的改革与完善提供建议。从政策发展历程、主要内容及政策特点等方面对日本高额疗养费制度和特定疾患财政补贴两种政策进行解读和评价。可通过按收入水平设置不同起付线、制定一系列减负措施、对特定疾病实施按病种补偿方式等来提升重大疾病保障水平。     

Reforming China's urban health insurance system

China's urban health insurance system is mainly consisted of labor insurance schemes (LIS) and government employee insurance scheme (GIS). LIS is a work unit-based self-insurance system that covers medical costs for the workers and often their dependents as well. GIS covers employees of the State institutions, is financed by general revenues. Since 1980s, China has implemented series of health insurance system reforms, culminating in the government's major policy decision in December of 1998 to establish a social insurance program for urban workers. Compared with the old insurance systems under LIS and GIS, the new system expands coverage to private sector employees and provides a more stable financing with its risk pool at the city level. Despite of these advantages, implementation of China's health insurance reform program is faced with several major challenges, including risk transfer from work units to municipal governments, diverse need and demand for health insurance benefits, incongruent roles of the central and regional governments. These challenges may reflect practical difficulties in policy implementation as well as some deficiencies in the original program design.     

The effects of public health insurance expansion on private health insurance in urban China

The public social health insurance coverage has rapidly increased in China in the last decade. The rapid market development and high economic growth also present an immense opportunity for the private insurance market. This paper uses the China Health and Nutrition Survey panel data and the difference-in-difference method to identify the causal effects of public health insurance expansion on private health insurance development in the case of expansion of the China Urban Residential Basic Medical Insurance (URBMI) program. The paper finds private health insurance enrollment is not affected by the introduction and expansion of URBMI. Rather, private health insurance plays supplementary roles. The findings present the challenges and opportunities for public policies to develop and regulate private health insurance to meet the market niches and provide health insurance to the demands of a heterogeneous population. The findings also have broader implications for other developing nations where public health insurance intends to rapidly expand towards the universal health coverage.     

Healthcare financing in Syria: satisfaction with the current system and the role of national health insurance--a qualitative study of householders' views

This study aims to identify the satisfaction with the current public health system and health benefit schemes, examine willingness to participate in national health insurance and review expectations and preferences of national health insurance. To this end, qualitative semi-structured interviews were carried out with 19 Syrian householders. Our results show that a need for health reform exists and that Syrian people are willing to support a national health insurance scheme if some key issues are properly addressed. Funding of the scheme is a major concern and should take into account the ability to pay and help the poor. In addition, waiting times should be shortened and sufficient coverage guaranteed. On the whole, the people would support a national health insurance with national pooling and purchasing under a public set-up, but important concerns of such a system regarding corruption and inefficiency were voiced too. Installing a quasi non-governmental organisation as manager of the insurance system under the stewardship of the Ministry of Health could provide a compromise acceptable to the people.