新型农村合作医疗降低就医经济风险的作用

Application of measuring method of economic risk for medical service in new-type rural cooperative medical system

目的:该文旨在探索在新型农村合作医疗(以下称新农合)的实践中如何运用就医经济风险测量方法。方法:运用某地数据进行示例分析,计算就医经济风险评议关键指标RR值和校正RR值,以此量化风险及其变化。结果:通过该方法,可以在明确风险分布的基础上,明确新农合的工作重点;通过比较新农合补偿前后风险的变化,为新农合方案的合理调整提供依据;明确就医概率、费用及风险之间的动态关系,为筹资费率测算奠定基础。

Objective： Applying measuring method of economic risk for medical service （ERMS） to newtype rural cooperative medical system （NRCMS）. Methods： Simulating with sample data, and calculating the key index of ERMS,RR and adjusted RR. Result： Using this method, we can describe distribution of ERMS among people, define working focus of NRCMS; Compare ERMS after reimbursement and provide evidence to adjust NRCMS project; Nail down relationship among probability of hospitalization, medical expense, and economic risk, then establish the foundation to calculate premium of NRCMS.