新疆新型农牧区合作医疗补偿模式研究  

Research on New Rural Cooperative Medical of Xinjiang’s Fund-raising and Pastoral

作　　者：王炳伟[1] 魏晶晶[1] 彭永 张晓明 瞿群 胡凯[1] 王才章[1] 阿依古丽 

机构地区：[1]新疆医科大学公共卫生学院,呼和浩特830011 [2]新疆维吾尔自治区卫生厅,呼和浩特830054

出　　处：《中国初级卫生保健》2009年第9期18-20,共3页Chinese Primary Health Care

基　　金：新疆医科大学软科学创新基金项目(2007-22)

摘　　要：目的根据2007年新疆新型农牧区合作医疗基金筹资及运行情况,重新调整新疆新型农牧区合作医疗的起付线、封顶线及住院补偿比,实现以地区为统筹单位,统一补偿模式,从而实现整合资源,降低管理运行成本,提高工作效率,发挥基金效益,提高抗风险能力的目的。方法按照经济发展水平和农牧民收入水平,分别从南疆、北疆、东疆随机分层抽取两地州2007年新型农村合作医疗相关数据,通过重新调整新型农牧区合作医疗的起付线、封顶线及住院补偿比,利用已经建立的公式和相关计算方法,对参合农牧民住院费用进行计算。结果2007年新疆维吾尔自治区若将乡级、县级及县级以上医疗机构起付线分别设定为80元、200元和500元,封顶线设为20000元,其住院补偿比例设为乡级70.00%,县级60.00%,县以上50.00%,能够实现基金收支基本平衡。结论从2007年新疆新型农牧区合作医疗基金筹资水平看,实施以地区级统一补偿模式是可行的。可有效提高基金使用率,扩大受益面,从长远来看,为实现全疆统一补偿模式提供理论依据。OBJECTIVE According to 2007 new cooperative medical of Xinjiang’ s fund-raising and pastoral, readjust operation new cooperative medical treatment pastoral , adjust the paying line、 top line、 the hospital compensation, to realize the area as a whole unit, unified compensation mode, so as to realize the integration of resources, reduce the management operation cost, improve work efficiency, increase efficiency, fund of anti-risk ability. METHODS According to the level of economic development and the farmer income levels, respectively from the Beikiang, Nankiang, Dongkiang, random extraction two districts in 2007 new iarming and related data, through the readjustment of the new cooperative medical treatment pay pastoral top line, and the hospital compensation has been estabhshed, use than formula and related calculation method, hospitalization expense of ginseng adds up to farmers. RESULTS If Xinjiang Uygur Autonomous region in 2007 at the township level, and above the county level and county-level medical institutions were set up from line to pay 80 yuan, 200 yuan, 500 yuan, 20 000 yuan cap set line, the proportion of compensation as the rural hospital 70.00% level, 60.00% at the county level, 50.00% above the county level, to achieve a basic balance between revenue and expenditure fund. CONCLUSION From the 2007 new cooperative medical fund and pastoral areas in xinjiang, to raise level of regional unified compensation model is feasible. Can effectively increase the fund utilization, expand benefited range, in the long run, to realize the unified compensation model provides theoretical basis.

关 键 词：新疆新型农牧区合作医疗 住院费用 测算 统一补偿模式 

分 类 号：R197[医药卫生—卫生事业管理]