新型农村合作医疗按人头支付政策干预的实证效果评价

发布时间：2018-06-19 00:18

本文选题：新型农村合作医疗 + 支付方式改革　；参考：《中国卫生经济》2017年07期

【摘要】：目的:对新型农村合作医疗按人头支付政策干预的实证效果进行评价。方法:收集2011—2015年浦东新区按人头支付干预前后新型农村合作医疗相关数据指标,评价政策干预对基金运行、就诊行为和补偿状况等的总体影响。结果:基金筹资水平不断提高,2015年人均筹资标准已达到2 000元/人;基金运行风险得到控制,2015年当年基金结余率达到8.84%;参合对象医疗服务需求逐年释放,2015年参合对象的年人均门诊就诊次数达到20次,年住院率为10%;医疗费用迅速增长的态势得到遏制,尤其次均住院费用增幅下降明显;2015年参合对象门诊和住院医疗费用的实际补偿比分别为60%和55%。结论:按人头支付政策实施3年多来,在费用控制方面取得了较好的效果。但在城乡基本医疗保险一体化管理的背景下,参合对象医疗费用的实际补偿比有待进一步提高。
[Abstract]:Objective: to evaluate the effect of the new rural cooperative medical policy intervention. Methods: the data indexes of the new rural cooperative medical system before and after the new rural cooperative medical treatment were collected from 2011 to 2015 in Pudong New area, and the overall influence of the policy intervention on the fund operation, consultation behavior and compensation was evaluated. Results: the level of fund raising has been increasing, the per capita funding standard has reached 2,000 yuan per person in 2015; The operating risk of the fund was controlled, the fund balance rate reached 8.84 in 2015, the medical service demand of the participants was released year by year, and the number of visits per person per year reached 20 times in 2015. The annual hospitalization rate is 10%, the trend of rapid increase of medical cost is contained, especially the increase of average hospitalization cost decreases obviously, and the actual compensation ratio of outpatient and inpatient medical expenses in 2015 is 60% and 55%, respectively. Conclusion: more than 3 years after the implementation of the policy, good results have been achieved in cost control. However, under the background of integrated management of urban and rural basic medical insurance, the actual compensation ratio of medical expenses of participating objects needs to be further improved.
【作者单位】：浦东卫生发展研究院;浦东新区卫生和计划生育委员会;浦东新区新型农村合作医疗管理办公室;浦东新区公利医院;复旦大学;
【基金】：国家自然科学基金项目(71503170) 上海市卫生和计划生育委员会科研课题(201440036,201540400) 上海市浦东新区卫生和计划生育委员会科技发展专项基金项目(PW2016A-4)
【分类号】：F323.89;F842.684;R197.1

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