基于结构变动度的新型农村合作医疗住院病人费用流向分析及政策探讨  

Flow Analysis and Policy Discussion on New Rural Cooperative Medocal System Inpatient Expenses Based on Structure Variation

作　　者：刘峥 高倩倩[2] 王培承[2] 韩晓伟[2] 

机构地区：[1]潍坊市人力资源和社会保障局,山东潍坊261061 [2]潍坊医学院,山东潍坊261053

出　　处：《中国卫生经济》2016年第7期23-26,共4页Chinese Health Economics

基　　金："健康山东"重大社会风险预测与治理协同创新中心重点研究方向项目(XT1401001;XT1405001);潍坊医学院科技计划项目(021709)

摘　　要：目的:分析潍坊市2009—2013年度新型农村合作医疗住院病人住院费用结构变化情况,把握新型农村合作医疗住院病人费用流向和基金流向,为构建合理诊疗秩序、控制参保人群医疗总费用过快增长以及提高新型农村合作医疗基金使用效益提供依据。方法:采用结构变动度、结构变动值和结构变动贡献率等指标,从住院总费用及其分项目两个层面进行统计分析。结果:2009—2013年,一级医疗机构住院费用占比呈逐年下降趋势,二、三级医疗机构住院费用占比呈总体上升趋势。住院总费用结构变动度为21.46%,分项目结构变动度为40.48%。二级医疗机构各项目结构变动贡献率最高,累计达59.73%。一级医疗机构各项目呈负向变动,二级医疗机构个人自负呈负向变动,其余项目呈正向变动。结论:新型农村合作医疗住院病人有向更高级别医院流动的趋势,新型农村合作医疗筹资水平提高与医疗总费用大幅度上涨并存,建议通过医改政策合力来促进分级诊疗,限制医疗费用的过度上涨。Objective： To analyze the structure variation of hospitalization expenses under New Rural Cooperative Medical System（NCMS） in Weifang from 2009 to 2014, provide references for acquiring the expense flow and fund flow of NCMS hospitalization, constructing rational health care order, controlling the excessive growth of the insured population total heahhcare expense and improving the utilization efficiency of NCMS fund. Methods： The structural variation degree, structural change and structural variation contribution rate were applied to conduct the statistical analysis from the total expenses and sub-items of hospitalization. Results： From 2009 to 2014, the proportion of the hospitalization expenses declining trend was in the first level hospital, and generally upward trend was in the second and third level hospital. The structural variation degree of total hospital expense was 21.46%, and the degree of structural variation of sub-items was 40.48%. The contribution rate of each project in the second level hospital was 59.73%, which was the highest. Each item hospital expense was in negative direction in the first level hospital, the individual expense was in negative direction in the second level hospital. The remaining items showed positive changes. Conclusion： There was flowing trend of NCMS inpatients towards higher hospitals. NCMS financing raised and total hospital expense raised coexisted. It suggested to promote classification treatment through health reform policy so as to limit the excessive increases of hospital expenses.

关 键 词：新型农村合作医疗 住院费用 费用流向 结构变动度 

分 类 号：R197.1[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]