甘肃省新型农村合作医疗住院患者流向及费用分析  

Analysis of the Inpatient Flow and Hospital Cost Among New Rural Cooperative Medical System in Gansu

作　　者：王震[1] 吴聪[1] 韩雪梅[1] 马莉[1] 郁娟[1] 陈永聪[1] WANG Zhen WU Cong HAN Xue-mei et al(School of Public Health, Lanzhou University, Lanzhou, 730000, Chin)

机构地区：[1]兰州大学公共卫生学院,兰州730000

出　　处：《中国卫生经济》2017年第2期33-35,共3页Chinese Health Economics

基　　金：2015年甘肃省自然科学基金项目(1506RJZA229);2015年兰州市科技计划项目(2015-2-52)

摘　　要：目的:对甘肃省2010—2015年新农合住院率、患者流向和费用负担等进行分析,探讨住院费用过快上涨的原因,发现新农合制度存在的问题。方法:从省新型农村合作医疗管理中心及华东公司提取2010—2015年新农合住院相关数据以及年度报表,分析方法采用卡方分析和描述性统计分析。结果:2010—2015年新农合住院率由6.37%提高到11.85%(χ2=503 005.45,P=0.000);流向县外医疗机构病人明显,县级医疗机构由41.05%提高到52.08%(χ2=103 245.25,P=0.000)。2010—2015年县外医疗机构住院费用最高为58%,乡级最少为7.53%。2010—2015年乡级、县级、县外医疗机构平均补偿比例分别为79.25%、66.30%和49.52%。结论:甘肃省新农合在住院服务利用、补偿费用不断提高等方面取得一定成效的同时,也存在患者就医流向不合理,补偿人次和补偿费用主要流向县及县外医疗机构,应遏制医疗费用过快增长,不断提高补偿水平,合理引导患者就医流向。Objective： To analyze the hospitalization rates, patient flow and cost burden in Gansu from 2010 to 2015, It explored the causes for the over-increasing of hospitalization costs and problems of new rural cooperative medical system（NCMS）. Methods： The data and annual reports about the NCMS operating status from 2010 to 2015 were collected from NCMS management office and Huadong company. Chi-square analysis and descriptive statistical analysis were applied. Results： The hospitalization rates of NCMS decreased from 6.37% to 11.85（χ^2=503 005.45, P=0.000）. The flow of patients chose to visit hospitals outside the county was obvious. The flow of county-level medical institutions increased from 41.05% to 52.08%（χ^2=103 245.25, P=O.O00）. Hospitalization expenses out- side the county accounted for 58% and township accounted for 7.53%. The average compensation ratio of township, county, and out- side were 79.25%, 66.30% and 49.52% respectively. Conclusion： The NCMS received certain achievements while there were still problems including unreasonable inpatient flow. The reimbursement number and expenses mainly flowed to the county and outside the county. It needed to control the over-increased medical expenses, continuously improve the reimbursement level and reasonably lead the flow of visiting doctors.

关 键 词：新型农村合作医疗 病人流向 住院费用 补偿比例 甘肃 

分 类 号：R197.3[医药卫生—卫生事业管理]