城乡医保一体化下新型农村合作医疗住院患者费用流向实证分析  

Empirical Analysis on the Flow Direction of Inpatient Medical Expenditure of New Rural Coopercotive Medical System under the Integration of Urban-Rural Medical Insurance

作　　者：于洗河[1] 赵璐[1] 李晓彤[1] 张野[1] 

机构地区：[1]吉林大学公共卫生学院,长春130021

出　　处：《中国卫生经济》2016年第4期31-33,共3页Chinese Health Economics

基　　金：吉林省科学技术厅项目(20140418058FG)

摘　　要：目的:通过分析城乡医保一体化模式下,2012—2014年长春市朝阳区新型农村合作医疗住院患者的就诊和医疗费用流向情况,探讨存在的主要问题并提出相应的对策。方法:对2012—2014年长春市朝阳区新型农村合作医疗患者在各级医疗机构的住院人次构成比、次均住院费用、次均个人自费和基金使用构成比等进行比较。结果:2012—2014年分流到省级和市级医院的住院人次、费用和新型农村合作医疗补偿费用逐年增加,2014年省级和市级医院住院人次分别为38.11%和42.51%。2012—2014年各级医院住院人次由高到低依次为市级、省级、区级和乡级。参合农民次均住院费用和次均个人自费由高到低依次为省级、市级、区级和乡级医院。2012—2014年新型农村合作医疗基金分流数额由高到低依次为省级、市级、区级和乡级医院。结论:城乡医保一体化模式下,长春市朝阳区参合农民的住院人次、住院费用和住院补偿费用分流到区级和乡镇级医院的比例逐年减少,次均住院补偿比在省级医院最高。Objective： Under the mode of urban-rural medical insurance integration, the main problems of the flow direction of the hospital visit and medical expenses for new rural cooperation medical system （NCMS） inpatients in Chaoyang District of Change- hun from 2012 to 2014 were analyzed and proposed corresponding countermeasures. Methods： It compared the inpatient constituent ratio, average hospitalization cost, average individual out-of-pocket（OOP） expense rate and fund utilization constituent ratio of NCMS patients in different levels of medical institutions of Chaoyang District in Changchun from 2012 to 2014. Results： From 2012 to 2014, the flow of visits, expenses and NCMS compensation expenses to provincial and municipal hospitals increased by years. The inpatient ratios of provincial and municipal hospitals in 2014 were 38.11% and 42.51%. From 2012 to 2014, the inpatient numbers in different levels of hospitals from high to low were municipal, provincial, district level and county-level hospitals. The average inpatient expenses for anticipated farmers and average individu＇,d OOP from high to low were provincial, municipal, district level and county-level hospitals. From 2012 to 2014, the NCMS fund flow amount from high to low were provicial, municipal, district level and county-level hospitals. Conclusion： Under the mode of urban-rural medical insurance integration, the flow ratio of inpatient number of anticipated tarmers, hospitalization expenses and inpatient compensation expenses in Chaoyang District of Changchun decreased by years in district-level and township hospitals. The average inpatient compensation ratio was the highest in provincial hospitals.

关 键 词：新型农村合作医疗 城乡医疗保险一体化 住院补偿 流向 

分 类 号：R197.3[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学] F323.89[经济管理—保险]