新型农村合作医疗参合农民住院费用案例分析  

Analysis on the Hospitalization Expenditures of the New Cooperation Medical System Participants

作　　者：杨才君[1,2] 蔡文芳[1,2] 沈倩[1,2] 朱稳稳 武丽娜[1,2] 李宗杰[1,2] 方宇[1,2] Yang Caijun Cai Wenfang Shen Qian Zhu Wenwen Wu Lina Li Zongjie Fang Yu(The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi＇an Jiaotong University, Xi＇an 710061, China The Center for Drug Safety and Policy Research, Xi＇an 710061, China)

机构地区：[1]西安交通大学药学院药事管理与临床药学系,西安710061 [2]西安交通大学药品安全与政策研究中心,西安710061

出　　处：《中国药事》2016年第12期1176-1182,共7页Chinese Pharmaceutical Affairs

基　　金：国家自然科学基金项目(编号71473192);美国中华医学基金会OC公开竞标项目(编号14-196);西安交通大学"青年拔尖人才支持计划"项目;西安交通大学青年教师跟踪支持项目(编号2015qngz05);西安交通大学科研支撑计划项目;中央高校基本科研业务费专项资金资助项目(编号sk2014041)

摘　　要：目的:分析陕西省新医改以来新型农村合作医疗参合农民的住院服务利用率、住院费用、自付住院费用的变化情况,为进一步完善新农合政策提供实证支持。方法:抽取陕西省蓝田县和合阳县的新农合系统内2009-2014年的住院补偿人次、住院总费用、住院补偿费用进行分析。结果:2009年以来,蓝田县和合阳县的住院率都呈现持续上升趋势,蓝田县在一级、三级医疗机构的住院率较高,而合阳县在二级医疗机构的住院率较高;次均住院费用方面,蓝田县和合阳县都呈现持续上涨趋势,但不同县内不同级别医疗机构的上涨幅度存在较大差异;次均自付住院费在两县都有小幅度下降,且随着医疗机构级别升高下降幅度降低。结论:新医改以来新农合政策的不断调整和变化,一方面提升了参合农民的医疗服务利用率,减轻了农民的医疗负担;另一方面,医疗费用持续上涨的趋势依旧存在。建议制定各级医疗机构合理分流的住院补偿比例,引导患者充分利用基层卫生资源,加强医疗机构监管,严格控制医疗费用的上涨。Objective： To analyze the hospital service utilization rates, hospitalization expenditures and hospitalization expenditures after reimbursement of the new cooperation medical system（NCMS） participants in Shaanxi Province since the new medical reform, and to provide empirical support for modifying the NCMS policies. Methods： The data of total number of hospitalizations, total hospitalization expenditures, total hospitalization subsidies of from 2009 to 2014 from the departments of the new cooperation medical system in Lantian County and Heyang County were obtained for trend analysis. Results： From 2009 to 2014, the hospitalization rates in both counties were rising. The hospitalization rates in the primary medical institutions and tertiary hospitals in Lantian were higher than those in Heyang, while Heyang had higher hospitalization rate in secondary hospitals. The average hospitalization expenditures in both counties were also increasing, but the rising rates were different due to different counties or different levels of medical institutions. The hospitalization expenditures after reimbursement in the two counties had small drops, and the decreasing rates in lower level medical institutions were higher than those in higher level medical institutions. Conclusion： The new policies of NCMS since the new medical reform are positive in increasing the hospital service utilization and reducing the medical burden of farmers. However, the medical costs are still rising. We suggest that reasonable hospitalization subsidy be provided for different levels of medical institutions to help patients to make full use of primary health resources and the supervision of medical institutions be strengthened to control the rising trend of medical expenditures.

关 键 词：新医改 新农合 农村医疗 医疗费用 住院率 住院费用 自付住院费用 

分 类 号：R95[医药卫生—药学]