I 摘要 “健康是人民全面发展的基础”，新型农村合作医疗是事关我国人民健康的重大民 生工程，党中央、国务院对此高度重视。党的十八大以来，习近平总书记也多次对医 疗保障的工作作出重要指示，他提出我们要全面建设中国特色医疗保险制度和大病医 疗保险制度。为了解决我国农民“看病难看病贵”的问题，避免农民“因病返贫”现 象的发生，我国在2009年作出深化医疗保险制度改革的重要部署，确立了新型农村合 作医疗在基层农村的重要地位。科学高效地使用新农合资金，确保新农合资金合理使 用，使新农合资金达到最优配置，可以维护参保农民的合法权益，减轻农民的经济负 担，促进城乡协调发展，缓解社会矛盾，在我国的经济发展中起着举足轻重的作用。 因此，加强对新农合资金的监管显得尤为重要。 新农合经过了十多年的运行，在资金筹集、资金支付等各个管理环节已经比较成 熟，形成了完整的服务体系，得到了农民朋友的认可和信任，参合率日益提高，新农 合投资规模越来越大，受益面积越来越广，给广大农民带来了福音。目前，新型农村 合作医疗已经在全国范围内得到了有效的实施，基本实现了全面覆盖。 本论文以山东省曹县新型农村合作医疗资金监管为研究对象，以曹县新农合资金 监管的现状及问题为出发点，通过调查相关数据资料和对新农合资金的筹集情况、支 付情况和补偿受益情况进行数据对比分析，可以看出曹县新农合在不断地发展和完善。 目前，曹县在新农合资金监管方面取得了以下成效:1、提高了曹县新农合运营的工作效 率；2、提高了曹县医疗机构的服务水平；3、减轻了曹县人民的就医负担。但是，新 农合资金在监管过程中仍然存在一些问题，具体如下:1、定点医疗机构违规操作；2、 资金管理存在漏洞；3、补偿机制不完善；4、相关法律法规不健全；5、参合人民缺乏 监督意识。定点医疗机构的违规操作,支付环节出现较多问题，导致了新农合资金的大 量流失。同时，政府为满足广大农民的就医需求，在筹资时将会增加个人和财政补助 额度，从而增加农民和政府的经济负担。针对曹县新农合资金监管中存在的问题，自 己通过对监管体质的深入分析与研究，提出以下整改措施：1、加强对定点医疗机构支 付过程的监管；2、增强参合人民的监督意识；3、完善科学合理的补偿机制；4、促进 相关法律法规的制定与完善；5、建立有效的资金管理制度。 对新农合资金的监管是一项长远而艰巨的任务，必须采取科学有效的措施去贯彻 落实，以确保新农合能够健康有序地发展，使得新农合资金达到最优配置，从而维护 参合人民的合法权益。 关键词：新型农村合作医疗；资金监管；使用效率 摘要 III ABSTRACT "Healthisthefoundationofpeople'sall-rounddevelopment",thenewruralcooperative medicalcareisamajorlivelihoodprojectconcerningthehealthofourpeople,theCPC CentralCommitteeandtheStateCouncilattachgreatimportancetothis.Sincethe18th NationalCongressoftheCommunistPartyofChina,GeneralSecretaryXiJinpinghasalso givenimportantinstructionsontheworkofmedicalsecurityonmanyoccasions,andhehas proposedthatweshouldcomprehensivelybuildthemedicalinsurancesystemwithChinese characteristicsandthemedicalinsurancesystemformajordiseases.Inordertosolvethe problemof"difficulttoseeadoctor"andtoavoidthephenomenonoffarmersreturningto povertybecauseofillness,Chinamadeanimportantdeploymenttodeepenthereformofthe medicalinsurancesystemin2009,andestablishedtheimportantpositionofthenewrural cooperativemedicaltreatmentinthegrass-rootsruralareas.Scientificandefficientuseof newagriculturalfunds,toensuretherationaluseofnewagriculturalfunds,sothatthe optimalallocationofnewagriculturalfunds,cansafeguardthelegitimaterightsandinterests ofinsuredfarmers,reducetheeconomicburdenoffarmers,promotethecoordinated developmentofurbanandruralareas,easesocialcontradictions,inChina'seconomic developmentplaysanimportantrole.Therefore,itisparticularlyimportanttostrengthenthe supervisionofnewagriculturalco-financing. Aftermorethantenyearsofoperation,inthefundraising,fundpaymentandother managementlinkshavebeenrelativelymature,formedacompleteservicesystem,hasbeen recognizedandtrustedbyfarmersfriends,participationrateisincreasingdaybyday,the scaleofnewagriculturalinvestmentisgrowing,thebenefitareaismoreandmorewide,to thevastnumberoffarmershavebroughtthegospel.Atpresent,thenewtypeofrural cooperativemedicaltreatmenthasbeeneffectivelyimplementedthroughoutthecountry,and hasbasicallyachievedcomprehensivecoverage. ThispapertakesthesupervisionofnewruralcooperativemedicalfundsinCaoCounty, ShandongProvince,andtakesthecurrentsituationandproblemsofthesupervisionofthe newagriculturalfundsinCaoCountyasthestartingpoint,andbyinvestigatingtherelevant dataandcomparingthedataonthecollectionofnewagriculturaljointfunds,thepayment situationandthecompensationbenefit,wecanseethatCaoCounty'snewagricultural cooperativeisconstantlydevelopingandperfecting.Atpresent,CaoCountyhasachieved thefollowingresultsinthesupervisionofnewagriculturalfunds:1,improvetheefficiency ofCaoCounty'snewagriculturaljointoperation;However,therearestillsomeproblemsin 西北农林科技大学硕士学位论文 IV thesupervisionprocessofnewagriculturalfunds,asfollows:1,fixed-pointmedical institutionsillegaloperation;Theillegaloperationoffixed-pointmedicalinstitutions,the paymentlinkappearsmoreproblems,resultinginalargeamountofnewagriculturalfunds lost.Atthesametime,inordertomeettheneedsofthevastnumberoffarmers,the Governmentwillincreasetheamountofpersonalandfinancialsubsidiesinthefinancing, therebyincreasingtheeconomicburdenonfarmersandtheGovernment.Inviewofthe problemsexistinginthesupervisionofnewagriculturalfundsinCaoCounty,throughthe in-depthanalysisandresearchofthesupervisionofthephysique,thefollowingcorrective measuresareputforward:1,strengthenthesupervisionofthepaymentprocessof fixed-pointmedicalinstitutions;Toestablishaneffectivefundmanagementsystem. Thesupervisionofnewagriculturalco-financingisalong-termandarduoustask,we musttakescientificandeffectivemeasurestoimplement,toensurethatthenewagricultural co-operationcandevelopinahealthyandorderlymanner,sothatnewfarmers... KEYWORDS:NewRuralCooperativeMedicalsystem;CapitalSupervision;Utilizationefficiency 目录 I 目录 摘要...........................................................................................................................................I ABSTRACT............................................................................................................................III 第一章导论...........................................................................................................................1 1.1选题背景.........................................................................................................................1 1.2国内外研究现状.............................................................................................................2 1.2.1国外研究现状..........................................................................................................2 1.2.2国内研究现状..........................................................................................................3 1.3研究目的与研究意义.....................................................................................................6 1.3.1研究目的...................................................................................................................6 1.3.2研究意义...................................................................................................................6 1.4研究思路与研究方法.....................................................................................................7 1.4.1研究思路...................................................................................................................7 1.4.2研究方法...................................................................................................................7 第二章山东省曹县新农合资金监管机制...........................................................................9 2.1新农合资金监管机制概览.............................................................................................9 2.2新农合资金监管机制.....................................................................................................9 2.2.1监管对象...................................................................................................................9 2.2.2监管依据.................................................................................................................10 2.2.3监管方式............