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目的:分析会宁县县外住院病人资料,探讨新农合支付方式改革和分级诊疗政策对住院病人县外就医行为和费用变化情况影响。方法:采用定性定量研究结合的方法,收集甘肃省和会宁县新农合报表资料进行描述性统计分析;收集支付方式改革和分级诊疗制度相关文件进行政策文件分析;对关键知情者进行访谈。结果:支付方式改革后县外就医比例增幅减小,逐渐转为下降趋势,个人支付比例降低;分级诊疗后县外就医人数比例与新农合资金支出比例下降,个人支付比例增高。结论:支付方式改革和分级诊疗对控制县外住院就医有积极作用;分级诊疗有效减少了县外住院就医和新农合资金支出比例,但个人自付费用有一定幅度上升。
OBJECTIVE: To analyze the data of inpatients outside Huining County, and to explore the impact of NRCMS reform and grading medical treatment policies on the behavior of inpatient outpatients and changes in costs. Methods: By means of qualitative and quantitative analysis, we collected descriptive statistics from the data of NRCMS in He-Ning County, Gansu Province. We collected the documents on the reform of payment methods and the related documents of Hierarchical Medical Treatment System and analyzed the policy documents. We interviewed key informants. Results: After the reform of payment methods, the proportion of medical expenses outside the county decreased and gradually turned downward, and the proportion of individual payment decreased. After the grading of medical treatment, the proportion of medical expenses outside the county and the proportion of new rural cooperative medical expenses decreased, and the proportion of individual payment increased. Conclusion: The reform of payment methods and grading diagnosis and treatment have a positive effect on the control of hospitalization outside the county. Grading diagnosis and treatment effectively reduce the out-of-hospital medical expenses and the proportion of new rural cooperative medical fund expenditures, but the personal out-of-pocket expenses increase to a certain extent.