新型农村合作医疗“按人头支付”改革的实证研究  

Empirical Study on the Capitation Reform of New Rural Cooperative Medical Scheme

作　　者：荆丽梅 孙晓明 崔欣 娄继权 李明 张群芳 陆国荣 浦良发 陈政 王峦 

机构地区：[1]浦东卫生发展研究院,上海200129 [2]浦东新区卫生局,上海200125 [3]浦东新区新型农村合作医疗管理办公室,上海201300 [4]上海市新型农村合作医疗管理办公室,上海201300 [5]上海市第六人民医院东院,上海201306

出　　处：《中国卫生经济》2014年第2期18-20,共3页Chinese Health Economics

基　　金：上海市浦东新区卫生系统优秀青年医学人才培养(PWRq2013-21);上海市卫生局局级科研项目(20124391);上海市浦东新区卫生局卫生科技项目(PW2012A-55;PW2012A-57);国家自然科学基金青年项目(71003024)

摘　　要：目的:设计新型农村合作医疗支付方式改革方案,并在上海市浦东新区全面推行改革试点的基础上,评价其改革效果及可推广性。方法:采用文献归纳分析、专家咨询论证、机构调查以及案例研究等方法进行改革方案的设计,并应用结构-过程-结果评价方法对改革效果进行评价分析。结果:新型农村合作医疗支付方式改革后,上海市浦东新区医疗费用的过快增长得到了控制,新型农村合作医疗住院基金运行更加安全,参合农民利益得到了保障。结论:基层医疗机构的地位举足轻重,须有效激励其改革的积极性;建议采取保险精算的理念,加强新农合"按人头支付"的风险评估和动态分析;需要建立健全配套的基金监管,确保基金使用的各个环节安全、高效;依托信息化手段,建立社区卫生服务机构与二、三级医院的费用协商和实时监管制度,实行服务协议管理和动态管理。Objective： To develop a program of capitation payment reform for new rural cooperative medical System（NCMS）, and implement it in Pudong New Area of Shanghai, and then evaluate the effect of the reform. Methods： Literature analysis, expert consultation, institution investigation, and case studies were used to develop the reform program, and structure-process-outcome frameword were used to evaluate the effects. Results： The payment reform can keep the excessive growth of medical costs under control, ensure the NCMS fund running safer, and safeguard the interests of participating farmers. Conclusion ： Primary health institutions play a pivotal role in capitation reform and their enthusiasm should be effectively motivated. Actuarial concepts should be introduced to strengthen the capitation reform＇s risk assessment and dynamic analysis. Matching funds regulatory system should be established to ensure the safety and efficiency of all aspects of fund use. Cost consultation and real-time monitoring system should be set to implement agreement and dynamic management, relying information technology.

关 键 词：新型农村合作医疗 支付方式改革 按人头支付 实证研究 

分 类 号：R197.1[医药卫生—卫生事业管理]