论文部分内容阅读
目的:探讨县外住院流向调整对新型农村合作医疗基金安全及居民补偿受益的影响,提出针对性对策和建议。方法:运用Excel 2010对湖北某县2004—2013年参合患者县外住院比重、住院费用及补偿情况进行分析,采用同机构比例调整法对县外住院比例进行调整。结果:县外住院人次比重、次均住院费用逐年增加且增速高于县级和乡级,2013年县外医疗机构36.05%的住院患者消耗了51.36%的补偿支出。2013年县外住院人次下降比重由1%到降至县域就诊90%时,节省的住院补偿费用比重由0.66%增加到17.30%,实际补偿比增量由0.59%增加到21.43%,参合费用人均节省量由2.15元增加到55.91元。结论:新型农村合作医疗大量的县外住院增加了患者就医负担和新型农村合作医疗基金安全风险,县外住院患者下沉可大大降低新型农村合作医疗基金的支出或提高参合居民的受益。建议建立合理的县域外就诊引导机制,强化县域外就医的筛选与分流;加强县级医疗机构与县外医疗机构的服务协作,降低域外就医比重;继续发挥新型农村合作医疗经济杠杆作用,拉开价格差距,体现县域内医疗机构价格优势。
Objective: To explore the impact of the adjustment of hospital flow in out-of-town on the safety of new-type rural cooperative medical fund and the benefit of resident compensation, and put forward some countermeasures and suggestions. Methods: By using Excel 2010, the proportion of outpatients outside the county from 2004 to 2013 in 2004-2003 in Hubei Province was analyzed. The proportion of inpatients outside the county was adjusted by proportional adjustment method. Results: The proportion of inpatients outside the county, the average cost of hospitalization increased year by year and the growth rate was higher than the county level and township level. In 2013, 36.05% of hospitalized patients in county medical institutions consumed 51.36% of the compensation expenses. In 2013, the proportion of inpatient reimbursement expenses saved increased from 0.66% to 17.30% and the actual compensation ratio increased from 0.59% to 21.43%, from 1% to 90% in county hospitals. The average cost per participant Savings increased from 2.15 yuan to 55.91 yuan. Conclusion: A large number of outpatients outside New Rural Cooperative Medical System (NCMS) have increased the medical burden on patients and the new rural cooperative medical fund. The sinking of outpatients outside the county can greatly reduce the expenditure of new rural cooperative medical fund or increase the benefit of participating residents. It is suggested that a reasonable guide mechanism should be set up to strengthen the screening and diversion of medical treatment at county level. The service cooperation between county-level medical institutions and medical institutions outside the county should be strengthened to reduce the proportion of medical treatment outside the county. The economic leverage of the new rural cooperative medical system should continue to be brought into full play. Price gap, reflecting the medical institutions in the county price advantage.