I 摘要 新型农村合作医疗大病保险，也称为“新型农村合作医疗二次报销”，是针对产 生大额医疗费用的参合患者给予再次报销的医疗保险制度。新型农村合作医疗在实施 过程中陆续产生一系列问题，比如政府部门工作人员少、压力大，以及报销时间较长、 基金运行风险等，面对这种情况，国家提出新型农村合作医疗大病保险由具有资质的 商业保险公司参与营运的指导性意见。 本文在政府购买服务、合作治理和顾客满意度理论的指导下，以中国人寿杨陵支 公司参与新型农村合作医疗大病保险为例，分析在参与业务、营运模式及本地特点三 个方面的现状，建立营运效果分析模型，从盈利、基金使用情况、补偿效果、顾客满 意度、对相关诊疗服务和医疗费用的监管五个方面进行深入研究，指出存在的问题并 剖析原因。 最后针对中国人寿杨陵支公司提出对策和建议:一是思想上重视，加强内部考核， 采取与医疗保障部门联合和以“第三方”承包的方式强化对相关医疗服务和医疗费用 的督导检查工作；二是通过简化业务经办流程、保障“一站式一单式”结算，缩短理 赔时长，提高顾客满意度；三是侧重对新型农村合作医疗大病保险制度的宣传，通过 采取多样化宣传方式提高顾客在政策及制度方面的知晓率。 通过本论文研究分析，旨在改善中国人寿杨陵支公司参与新型农村合作医疗大病 保险的营运模式，进一步提高顾客满意度，在一定程度上也能丰富商业保险公司介入 新型合作医疗大病保险的形式。 关键词：中国人寿；新型合作医疗；大病保险；营运；效果西北农林科技大学硕士学位论文 II ABSTRACT The new rural cooperative medical insurance, also known as the "new rural cooperative medical secondary reimbursement", is a medical insurance system to re reimbursement the patients who have a large amount of medical expenses. There are a series of problems in the implementation of the new rural cooperative medical system, such as the lack of government staff, high pressure, long reimbursement time, fund operation risk, etc. in the face of this situation, the state proposed that the new rural cooperative medical insurance should be operated by qualified commercial insurance companies. Under the guidance of government purchase service, cooperative governance and customer satisfaction theory, Taking Yangling branch of China Life Insurance Company as an example, this paper analyzes the current situation of participating in business, participating in the operation mode of new rural cooperative medical insurance and local characteristics, and establishes the operation effect analysis model from the aspects of profit, fund use, compensation effect, customer satisfaction and relevant diagnosis This paper makes an in-depth study on the supervision of medical services and medical expenses, points out the existing problems and analyzes the reasons. Finally, the paper puts forward countermeasures and suggestions for Yangling branch of China Life Insurance Company: first, focus on the publicity of the new rural cooperative medical insurance system, and improve customers' awareness of the policy and system by adopting diversified publicity methods; second, by simplifying the operation mode and ensuring "one-stop one-way" settlement, shorten the claim settlement time and improve customer satisfaction; third, attach great importance to ideology It is necessary to strengthen the internal assessment, and strengthen the supervision and inspection of relevant medical services and medical expenses by means of joint efforts with medical security departments and "third party" contracting. Through the research and analysis of this paper, the purpose is to improve the operation mode of China Life Yangling branch company participating in the new rural cooperative medical insurance, further improve customer satisfaction, and to a certain extent, enrich the form of commercial insurance companies involved in the new cooperative medical serious illness insurance. KEY WORDS: China Life Insurance; New Cooperative Medical System; Serious Illness Insurance; Operation; Commercial Insurance Company目 录 I 目 录 摘要...........................................................................................................................................I ABSTRACT ............................................................................................................................ II 第一章 导论..........................................................................................................................1 1.1 研究背景 .................................................................................................................... 1 1.2 目的和意义 ................................................................................................................. 1 1.2.2 研究目的 ........................................................................................................... 1 1.2.3 研究意义 ........................................................................................................... 2 1.3 国内外研究概况 ......................................................................................................... 2 1.3.1 国外研究概况 .................................................................................................. 2 1.3.2 国内研究概况 ................................................................................................... 3 1.3.3 文献述评 ........................................................................................................... 4 1.4 研究思路及研究方法 ................................................................................................. 4 1.4.1 研究思路 .......................................................................................................... 4 1.4.2 研究方法 ........................................................................................................... 5 第二章 基本概念与相关理论..............................................................................................6 2.1 基本概念 .................................................................................................................... 6 2.1.1 商业保险 .......................................................................................................... 6 2.1.2 新型合作医疗 ................................................................................................... 6 2.1.3 大病保险 ........................................................................................................... 6 2.1.4 新型合作医疗大病保险 ................................................................................... 7 2.1.5 商业保险公司参与新型合作医疗大病保险 ................................................... 7 2.1.6 营运 ................................................................................................................... 8 2.2 相关理论 .................................................................................................................... 8 2.2.1 政府购买服务理论 .......................................................................................... 8 2.2.2 合作治理理论 ................................................................................................... 9 2.2.3 顾客满意度理论 ............................................................................................... 9 第三章 中国人寿参与新型合作医疗大病保险的现状....................................................10 3.1 中国人寿杨陵支公司及参与业务概述 ................................................................... 10 3.1.1 中国人寿杨陵支公司的基本情况 ................................................................ 10 3.1.2 参与业务概述 ................................................................................................. 10西北农林科技大学硕士学位论文 II 3.2 中国人寿参与新型合作医疗大病保险营运方式 .................................................. 11 3.2.1 中国人寿杨陵支公司参与新型合作医疗大病保险成本投资 .................... 11 3.2.1.1 人力投资 ...................................................................................................... 11 3.2.1.2 信息化系统投资 .......................................................................................... 11 3.2.2 中国人寿杨陵支公司参与新型合作医疗大病保