我国城镇居民基本医保和新农合支付水平差异分析  

Analysis of the Payment Differences between Urban Residents Basic Medical Insurance and New Rural Cooperative Medical Scheme in China

作　　者：许正圆 徐伟[1] 

机构地区：[1]中国药科大学国际医药商学院,江苏南京211198

出　　处：《医学与哲学（A）》2016年第12期63-65,90,共4页Medicine & Philosophy:Humanistic & Social Medicine Edition

基　　金：2012年国家自然科学基金面上项目;项目编号:71273278

摘　　要：通过分析我国城镇居民基本医保和新农合基金对参保患者医疗总费用、门诊及住院费用的支付水平,探究二者支付水平的差异,为促进医保城乡统筹提供政策借鉴。研究结果显示,我国城镇居民医保基金多用于支付高医疗费用,说明其对高额医疗费用患者的保障力度更强,体现了"保大病"的制度设计理念;而新农合基金主要用于支付中低医疗费用,对高医疗费用的支付力度不大,说明其更好地缓解了中低费用患者的疾病经济负担。二者起付线、支付范围、封顶线及支付模式不同是导致支付水平差异的主要因素。To explore the payment differences between urban residents basic medical insurance （URBMI） and new rural cooperative medical scheme （NRCMS）, this article analyzed the funding compensation ability to the outpatient and inpatient beneficiaries＇ health expenditures respectively. The results showed that the funding of URBMI were mostly used to compensate high health expenditures but the NRCMS mainly focused on compensating the beneficiaries whose health expenditure was comparatively lower. The differences of deductible, compensation scope, limit line and payment model between URBMI and NRCMS were the main factors that caused payment differences.

关 键 词：城镇居民基本医疗保险 新农合 支付水平差异 

分 类 号：R197[医药卫生—卫生事业管理]