新农合住院报销政策调整效果探讨——以湖北A市为例

发布时间：2018-07-12 20:39

本文选题：新农合 + 住院　；参考：《中国卫生事业管理》2014年08期

【摘要】：目的:了解新农合住院报销政策的调整效果,切实减轻住院患者疾病经济负担,为完善新农合制度提供相应的政策建议。方法:运用SPSS17.0统计软件对湖北A市2010-2012年新农合患者就医费用数据进行分析。结果:政策调整后,A市就医格局合理化,卫生资源利用率极大提升;实际补偿比提高,参合农民负担减轻,健康意识增强。但是住院量增幅较大,可能存在不合理住院现象,新农合基金压力大;市外就医患者实际补偿比仍然较低(45.83%)。结论:提高基层医疗机构服务能力;继续发挥新农合的经济杠杆调节作用;加强门诊补偿,控制住院率,减少不合理的住院;关注高额费用患者,提高实际补偿比;坚持动态管理原则,科学设计和调整新农合补偿政策。
[Abstract]:Objective: to understand the adjustment effect of the NCMS inpatient reimbursement policy, to reduce the economic burden of the inpatients, and to provide the corresponding policy suggestions for the improvement of the NCMS system. Methods: SPSS 17.0 statistical software was used to analyze the data of medical expenses of NCMS patients from 2010 to 2012 in A City of Hubei Province. Results: after the policy adjustment, the pattern of medical treatment was rationalized, the utilization rate of health resources was greatly improved, the actual compensation ratio was increased, the burden of participating farmers was lightened, and the health awareness was enhanced. However, the increase of hospitalization amount is large, there may be unreasonable hospitalization phenomenon, the pressure of NRCF is great, and the actual compensation ratio of out-city patients is still low (45.83%). Conclusion: improve the service ability of primary medical institutions; continue to play the role of economic leverage of NCMS; strengthen outpatient compensation, control the rate of hospitalization, reduce unreasonable hospitalization, pay attention to patients with high costs, improve the actual compensation ratio; Adhere to the principle of dynamic management, scientific design and adjustment of the new rural cooperative compensation policy.
【作者单位】：仙桃市新农合管理办公室;湖北省肿瘤医院;
【基金】：湖北省卫生政策项目“重大疾病保障机制研究”(编号:ZC2012-3)
【分类号】：R197.1;F842.684;F323.89

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