我市新型农村合作医疗制度实施的现状与对策

新型农村合作医疗制度是由政府组织、引导和支持，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。2003年以来，我市“新农合”试点工作进展顺利．规范管理和运行机制初步形成，基金运转安全，制度运行平稳．农村居民医疗服务利用率明显改善，医药负担有所减轻，在一定程度上缓解了农民“因病致贫、因病返贫”问题。     

关于新型农村合作医疗若干问题的对策

目前广大农村已全面建立起新型农村合作医疗(以下简称新农合)制度,农村居民医疗负担得到减轻,因病致贫、因病返贫的状况得到缓解。在实行中也存在着诸多问题,新农合制度的前行依然面临着困局,在深入调查的基础上提出了一些可行性对策。     

广西新型农村合作医疗中存在的问题与对策

建立和完善新型农村合作医疗制度,是当前党和政府加快社会主义新农村建设,切实解决农民因病致贫、因病返贫问题的重要举措。本文根据当前广西新型农村合作医疗运行的基本情况,阐述并分析了新农合在后期推广过程中存在的问题,提出完善广西新型农村合作医疗的几点建议,以促进新农合的实施及三农政策的落实。     

西部农村新型合作医疗制度设计中的悖论及实施中的困境分析

西部农村新型合作医疗制度是一项旨在解决农民因病致贫、因病返贫的惠民制度,实施以来已经取得一定的绩效,但在具体运作中也遇到了诸多问题。分析新型农村合作医疗制度在西部地区实施中困境所在,应从构建科学、合理的筹资机制、补偿机制、监管机制等方面加以解决。     

看病难看病贵的基层感触

在农村流传着一句话,"小病扛,大病拖,病重才往医院抬。"人民群众看病难、看病贵,甚至因病返贫,因病致贫,这一民生难题,尽管随着新型农村合作医疗制度的建立,包括一些地     

盐城率先力破弱势群体医疗保障难题

江苏省盐城市委,市政府高度关注弱势群体医疗保障,于2004年10月在全国率先出台了市区城市居民医疗统筹和医疗救助相结合的制度,坚持政府主导、财政补助、个人缴费、社会援助相结合的办法,构造”就医助困“长效机制。实行低保、特困、重残人员政府每人每年补贴140元,个人出资60元;普通城市居民政府每人每年补贴60元,个人出资140元,筹资945．7万元,建立医疗统筹制度;由政府、财政、红十字会、慈善总会等多方筹资150万元,建立医疗救助制度;从制度上保证了城市居民人人享有医疗保障,低保、特困、重残及大重病患者等弱势群体因病致贫,还可以享有医疗救助,有效缓解了“因病致贫、因病返贫”的社会问题,探索破解“就医难、看病贵”的难题。其成效主要体现在三个方面:     

为农民保健康 让群众得实惠——访山东省章丘市卫生局党委书记、局长孟庆杰

没有农民健康,就没有社会全面小康。中国9亿农民的“疾病防治”、“因病致贫”问题深深地牵动着中央领导的心。党的十六届三中全会明确提出,要改善乡村卫生医疗条件,积极建立新型农村合作医疗制度,实行对贫困农民的医疗救助。山东省章丘市认真贯彻中央指示精神,以人民健康与发展地方经济建设为中心,围绕加强农村卫生     

新型农村合作医疗制度绩效评价的研究新进展

自新型农村合作医疗制度2003年试点以来,迅速发展成为我国重要的农村基本医疗保障制度,学者对新型农村合作医疗制度绩效如何开展了广泛而深入的研究。本文探讨了近十年来新型农村合作医疗制度绩效研究的新进展,这些研究包括三大部分:一是新型农村合作医疗制度绩效的内涵,二是新型农村合作医疗制度绩效评价的主要内容,三是新型农村合作医疗制度评价的方法。本文认为新型农村合作医疗制度绩效评估还可从减少效率损失的角度研究如何提高绩效、新农合制度应与农村居民的医疗服务需求相适应,这将是新型农村合作医疗制度绩效评估的新的动向。还应进一步注重计量模型的选择,从而更加精确测量新型农村合作医疗制度的绩效。     

建立健全新型农村合作医疗制度亟待解决的几个问题

在现阶段,新型农村合作医疗制度就是农村医疗社会保险制度,建立健全新型农村合作医疗制度亟待解决的问题:一是增加政府对农村医疗卫生事业的投入,扩大新型农村合作医疗覆盖面;二是建立规范的筹资机制,合理确定人均筹资水平;三是建立大病统筹和个人门诊账户制度,落实新型农村合作医疗基金的合理补偿。     

新型农村合作医疗基金监管中的问题与对策

新型农村合作医疗制度是缓解农村居民“看病难,看病贵”的一项社会保障制度,惠及了绝大多数的农村居民,是面向全体农村居民的医疗福利。近年来,新农合基金监管中存在着严重的漏洞,导致新农合资被骗现象时有发生,因此应从多元主体参与监管与新农合监管的运行机制两方面完善新农合基金的监管。     

我国农村人力资本投资的制约因素与对策分析

加大人力资本投资力度,充分发挥农村人力资本的资源优势是我国解决“三农”问题、建设社会主义新农村的一大重要举措。而由于农村居民人均收入低、城市优先发展策略、农村人力资本投资收益率低下、农村劳动力在城市的非正规就业等原因,严重阻碍了农村人力资本的投资行为。故而,笔者建议:政府应加大对农村义务教育投资力度,大力发展农村职业技术教育,提高农村人口的整体文化水平;大力发展农村合作医疗事业;形成城乡统一的劳动力市场,提高农村人力资本投资回报率,从而提高农村人口的整体素质,变人口压力为人力资源优势。     

National health insurance: Some lessons from the Canadian experience

In the current American debate over national health insurance an examination of the Canadian governmental experience is very instructive. Canada is enough like the United States to make the effects of Canadian health insurance policies rather like a large natural experiment. The Canadian experience—universal government health insurance administered by the ten provinces with some fiscal and policy variations—can be used to predict the impact in the United States of proposed national health insurance plans on the medical care system, and the reaction of mass publics and national policymakers to these effects.The central purpose of the Canadian national health insurance was to reduce and hopefully eliminate financial barriers to medical care. In this it succeeded. But it also produced results which Canadian policymakers never anticipated: essentially unexpected side-effects on cost, quality, organization, and manpower distribution of the particular national health insurance program adopted. It should be cause for concern, the article concludes, that most of the prominent American national health insurance proposals resemble the Canadian program in failing to provide a single level of government with both the means and incentives to curb the inflationary effects of national health insurance. The lesson from Canada is that unless the system has very strong anti-inflationary mechanisms and incentives built into it, national health insurance will feed the fires of medical inflation despite great formal governmental authority to control it.     

POLITICAL VALUES IN A CHANGING RURAL COMMUNITY

This survey data from a rapidly growing rural community reports on the attitudes and expectations residents have toward government. These residents, influenced by their "politics of escapism" from urban living, are oriented to relationships with a few friends and neighbors and a sense of community cooperation. Rather than being primarily interested in better public services, these residents possess a larger view of the values of a rural life style and a willingness to accept less service as its cost.     

反贫困与少数民族聚居区新型农村合作医疗制度的优化——以内蒙古、云南为例

少数民族聚居区贫困人口问题,不仅是一个经济社会问题,也是十分重要的政治问题。因病致贫、因病返贫是少数民族聚居区农牧民贫困的主要原因之一。民族聚居区农牧民贫困具有区域贫困与农牧民个体贫困并存,贫困发生率高等一些共性的特征。贫困对少数民族聚居区新农合制度可持续发展具有制约性,只有对少数民族地区聚居区新农合制度进行优化设计,才能促进该制度的可持续发展。     

人口老龄化与农村老年医疗保障制度

人口老龄化导致老年人医疗服务需要增加。然而,经济因素制约了老年人医疗服务需要向需求的转化,阻碍了老年人健康状况的改善。为实现世界卫生组织(W H O)提出的“健康老龄化”目标,促进全面建设小康目标的实现,必须为老年人尤其是收入低且几乎没有任何医疗保障的大量农村老年人建立医疗保障制度。建立制度面临筹资来源少、技术难度高、医疗卫生条件落后等制约因素,需要采取“低水平、广覆盖、采用多种模式、利用各方力量、加强配套设施”的发展策略。通过建立农村老年医疗救助、合作医疗、“时间储蓄”等多种制度,提供完善的医疗供方体系,保障农村老年人的基本医疗需求,促进其健康状况的改善。     

The dilemmas of incrementalism: logical and political constraints in the design of health insurance reforms.

Health care reform became a premier issue on the U.S. policy agenda in the 1990s. While the comprehensive proposal put forth by President Clinton failed, states and the federal government successfully pursued a variety of lesser initiatives. This article focuses on a set of reforms intended to make private health insurance more accessible and affordable to individuals and workers in small firms. It outlines the key arguments made by experts to justify stronger regulation of health insurance and the options and difficult tradeoffs that must be considered in policy design. It then examines the scope and strength of legislation adopted by 45 states and the federal government from 1990 to 1996. The substantial variation in state policies demonstrates that even though insurance market reform was the one issue that commanded nearly universal support in the health care debate, few design features were universally accepted by those who crafted the reforms. The article concludes by assessing the pattern of state and federal action. The reforms represent some progress on nominal access to insurance but little progress on the affordability of insurance for individuals and small groups. Few of the reforms present a serious challenge to existing practices and interests of the insurance industry. This pattern of policy design reflects the logical and political constraints of incrementalism. In a system where insurance coverage is voluntary, changes to increase access for one group tend to increase costs and thereby decrease access for another segment of the population. In addition, because incremental reforms will not attract sustained attention and support from the general public, it is politically difficult to impose substantial new regulation on a powerful industry.     

Mental health and substance abuse insurance parity for federal employees: How did health plans respond?

A fundamental concern with competitive health insurance markets is that they will not supply efficient levels of coverage for treatment of costly, chronic, and predictable illnesses, such as mental illness. Since the inception of employer-based health insurance, coverage for mental health services has been offered on a more limited basis than coverage for general medical services. While mental health advocates view insurance limits as evidence of discrimination, adverse selection and moral hazard can also explain these differences in coverage. The intent of parity regulation is to equalize private insurance coverage for mental and physical illness (an equity concern) and to eliminate wasteful forms of competition due to adverse selection (an efficiency concern). In 2001, a presidential directive requiring comprehensive parity was implemented in the Federal Employees Health Benefits (FEHB) Program. In this study, we examine how health plans responded to the parity directive. Results show that in comparison with a set of unaffected health plans, federal employee plans were significantly more likely to augment managed care through contracts with managed behavioral health "carve-out" firms after parity. This finding helps to explain the absence of an effect of the FEHB Program directive on total spending, and is relevant to the policy debate in Congress over federal parity.     

Policy reform and rural development assistance in Tanzania

Tanzania for a long time refused to reform its economic policies along the lines recommended by the World Bank and IMF. Eventually the foreign exchange crisis forced the government to make the changes advocated by its own pragmatic economists and the Western donor community. The reforms were necessary, but not a panacea for all the problems which had plagued rural development programmes over the past decade. Three big problems still face basic-needs programmes: the government administration has very little capacity to manage or back up programmes; neither the national nor district governments can afford them; and rural residents have not compensated for either of these deficiencies through their own participation and contributions. This article looks at two basic-needs programmes in the rural water supply sector to illustrate how these long-standing problems continue to affect implementation. Both programmes are funded and implemented by donors. The conclusion is that donors have not been sufficiently self-conscious and innovative in grappling with the more intractable problems facing rural programme assistance in Tanzania.     

统筹城乡发展与地方政府——基于浙江省长兴县的研究

统筹城乡发展、建设新农村是全面贯彻落实科学发展观、构建和谐社会的重要内容和途径。其中,政府必须扮演关键性的角色,而在各级政府中,县级政府又负有最直接的责任。浙江省长兴县统筹城乡发展、建设新农村的基本经验是:政府必须承担统筹城乡发展、建设新农村的主要责任,通过建立领导机制、政府体制创新等有效地整合资源、制订规划、组织实施;政府必须在建设农村基础设施、治理和保护农村自然环境、建立健全医疗、养老等农民社会保障体系、支持农业生产、发展教育事业等方面发挥关键性作用;政府必须尊重市场规律,重视社会力量,尊重农民的主体地位、首创精神和权利,形成政府、企业、社会三者之间互补、合作的良好格局,合力解决实际进程中的困难;政府必须因地制宜,因时制宜,制订并实施基于当地现实、适应当地现实、全面、渐进解决当地现实问题的公共政策。     

宁夏城乡二元社会保障法律制度的现状与问题分析

中国的二元经济结构,导致了包括宁夏在内全国实行城乡二元社会保障法律体系。目前,宁夏农村社会保障体系建设仍然滞后于城镇社会保险体系。农村居民的社会保障水平不高。宁夏城镇居民的社会保险、社会救济、社会福利和社会优抚安置已经建立了相对完善的体制和制度。可是在农村,上述基本社会保障体制和制度仍在积极探索和完善中,城乡社会保障工作还存在相当大的差距。