新医改下新型农村合作医疗住院患者流向及医疗费用研究:以湖北省某县为例  

Study on the Distribution and Medical Expense of Inpatients under the New Medical Reform: Using a County of Hubei as Case Study

作　　者：罗飞[1] 姚岚[1] 陈凯[1,2] 刘智勇[1] 吴姝德[1] 李云飞[1] 何露洋[1] 邓德武 曾庆源 

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,武汉430030 [2]国家卫生和计划生育委员会基层司,北京100191 [3]湖北省来凤县卫生局,湖北武汉445700 [4]武汉市第三医院,湖北武汉430070

出　　处：《中国卫生经济》2015年第2期60-62,共3页Chinese Health Economics

基　　金：湖北省卫生厅卫生政策科研项目(ZC2012-19)

摘　　要：目的:探讨新医改的实施对样本县患者就医流向变化及新型农村合作医疗基金流向的影响,提出针对性对策和建议。方法:通过现场调查获取该县新型农村合作医疗相关数据,采用描述性方法对2009—2012年新型农村合作医疗住院病人就诊医疗机构选取情况、住院总费用、新型农村合作医疗基金补偿费用、次均医疗费用、次均自付费用、政策补偿比及实际补偿比等指标进行分析。结果:样本县新型农村合作医疗患者选择乡镇卫生院的占比有逐年减小的趋势,选择县级及县外医疗机构就医的趋势在扩大,因此也导致了新型农村合作医疗补偿基金更多地流向了县级及县外医疗机构,其占比增大的趋势明显。结论:仅通过新型农村合作医疗的报销政策引导患者"下沉"到基层医疗机构在该县的效果不明显,医保的经济杠杆作用难以完全促进患者的合理就医流向,若不改善患者就医流向的结构,样本县新型农村合作医疗基金运行将面临巨大的筹资压力和运行压力。Objective:To discuss the influence of implementing new medical reform on distribution change of patients health seek-ing behavior in the county and the distribution of new rural cooperative medical system(NCMS) fund. Targeted suggestions and adviceswere proposed.Methods:Descriptive method was used to analyze the indicators of NCMS inpatients’ choosing situation of medicalinstitutions, total hospitalization expense, NCMS funding reimbursement expense, average medical expense, average self-paying ex-pense, policy reimbursement ratio and actual reimbursement ratio.Results:The proportion of NCMS patients of the target countychoosing township healthcare had decreasing trend by years, the trend of choosing township medical institutions and medical institu-tions outside the county was enlarging, which also resulted in the NCMS reimbursement expense tended to flow to township medical in-stitutions and medical institutions outside the county. The proportion of increasing trend was obvious.Conclusion:The effect of usingNCMS reimbursement policy to lead patients 'sinking' to primary medical institutions of the county was not obvious, the economicleverage of medical insurance could not completely promote the reasonable distribution of patients in seeking medical services. TheNCMS fund operation of the county would face large financing pressure and operation pressure if the distribution structure of patientsseeking medical services were not promoted.

关 键 词：新型农村合作医疗 就医流向 医疗费用 湖北 

分 类 号：R197.1[医药卫生—卫生事业管理]