如何增强农村基层门诊服务的可及性--宁夏新农合福利包改革设计与效果  

How to enhance access to basic outpatient services in rural areas: Design and outcomes of the benefit package reform of NRCMS in Ningxia

作　　者：祝菁菁[1] 胡敏[1] Winnie C-M Yip 陈文[1] 

机构地区：[1]复旦大学公共卫生学院,上海200032 [2]牛津大学布拉瓦尼克政府学院

出　　处：《中国卫生政策研究》2014年第8期9-13,共5页Chinese Journal of Health Policy

基　　金：盖茨基金会项目(OPPGH5252);国家社会科学基金重大项目(11&ZD176)

摘　　要：在新医改进程中,各地需要立足现实,探索细致的改革策略及机制,以实现"保基本、强基层、建机制"的目标。本文以宁夏回族自治区为案例,对新农合保障范围和水平进行改革设计,纳入基层门诊服务并予以较高报销比例,随后进行自然实验设计,并利用2009—2012年入户调查面板数据以及倍差法对实际干预效果进行评估。研究发现,实施趋向于基层门诊服务的福利包增加了居民利用村卫生室门诊服务的可能性,但是这一影响随着人们的教育水平、收入水平、住所与医疗机构距离等的不同而不同。Every local government is required to explore specific strategies and mechanisms based on local conditions to meet the overall goals of health system reforms in China.This article introduces the case of Ningxia Hui Autonomous Region in which the benefit packages of the New Rural Cooperative Medical Scheme （NRCMS）were redesigned in pilot counties to include basic outpatient care and provide much higher reimbursement rates.The effects of the policy intervention on healthcare utilization were then evaluated based on a natural experiment design and a difference-in-difference approach using 2009-2012 household panel data.The findings suggested that the expansion of the NRCMS benefit package increased the likelihood of people using outpatient care at village clinics.However,heterogeneity in the impact of the benefit package policy change was detected with regards to educational level,household wealth and geographical access to the facility.

关 键 词：新型农村合作医疗 福利包 门诊 利用 可及性 异质性 

分 类 号：R197[医药卫生—卫生事业管理]