新农合制度运行现状分析——基于6省14县的调查

发布时间：2018-03-31 05:02

本文选题：新型农村合作医疗　切入点：基金　出处：《中国卫生政策研究》2016年02期

【摘要】：目的:比较分析新农合住院服务利用、补偿、基金等方面运行情况,了解各地新农合的进展。方法:东、中、西部各选2个省,每个省随机选择2个县(江苏、广西抽取3个)作为样本县,对14县新农合基金和住院服务情况进行描述性分析和比较分析。结果:2012和2013年平均筹资水平分别为300和350元左右;利用县外医疗机构住院服务比例较高,I县甚至超过40%;除江苏、安徽外,其他四省住院补偿受益率超过10%;除福建外,住院实际补偿比超过50%;各县次均住院费用差异较大,2013年上涨明显;个人自付次均住院费用占农民人均纯收入的比例各县不同,部分县2013年有所下降;流向县外医疗机构的基金比例较高,G县甚至超过50%;当年基金多发生赤字,基金累计结余率在1%~2%之间。结论:新农合筹资水平较低,个人筹资责任较轻。住院服务利用结构不尽合理。住院实际补偿比提升乏力,群众医疗费用负担缓解不明显。基金可能存在监管乏力,且风险较高。
[Abstract]:Objective: To compare the hospitalization compensation service utilization, NCMS, fund operation situation, to understand the progress over the NCMS. Methods: East, West, the election of the 2 provinces, each province, randomly selected 2 counties (Jiangsu, Guangxi from 3) as a sample of the new agricultural county, 14 county hospital and fund service descriptive analysis and comparative analysis. Results: the average level of funding in 2012 and 2013 respectively 300 and 350 yuan; the use of inpatient services outside the county medical institutions of higher proportion of I County, even more than 40%; in addition to Jiangsu, Anhui and other four provincial hospital benefit rate of compensation of more than 10%; in addition to Fujian, the actual hospital compensation more than 50% counties; the average hospitalization cost differences, 2013 rose significantly; the individual pays the average hospitalization expenses accounted for the county per capita net income of farmers in different proportion, part of the county declined in 2013; went out of the county medical institutions to fund a higher proportion, G County, even more than 50% year; fund deficit, fund accumulated balance ratio between 1%~2%. Conclusion: the financing level is low, the individual financing responsibility lighter. Inpatient service utilization structure is not reasonable. In the actual compensation ratio increase is weak and the burden of medical costs. There may be no obvious relief fund supervision, and the higher the risk.

【作者单位】：中国医学科学院医学信息研究所卫生政策与管理研究中心;
【基金】：国家卫生和计划生育委员会委托项目
【分类号】：R197.1;F842.684;F323.89

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