农村合作医疗筹资额和补偿比间数量关系模型与检索表的研究

Quantitative Relationship Between Financing and Reimbursement and Its Application in Rural Cooperative System

为科学测算农村合作医疗筹资额和补偿比,以保持合作医疗系统的正常运转,本研究在综合农村合作医疗和健康保险筹资额与补偿比测算研究方法的基础上,进一步对合作医疗筹资额和补偿比间数量关系模型作了研究;针对目前各地若干种不同补偿范围和项目的合作医疗,利用对山东省农村居民在不同级别医疗机构人均门诊、住院医药费用的调查结果,编制了筹资额和补偿比间数量关系检索表,使人均筹资额的测算和医药费用补偿比的确定更为简明易行、灵活多样、便于操作。该研究方法对在全国范围内恢复和发展农村合作医疗提供了一种科学的技术指导和决策思路。

In order to estimate the financing and reimbursement rate in rural Medical Cooperative System(CMS), the model of quantitative relationship between the amount of financing and reimbursement is investigated based on a summary of the current available methods and on a survey of households for their use of and expenditure for health care in Shandong. The direct outcome of this study is a tool table which can be used by the CMS practiticners to search for the amounts of financing according to different reimbursement rates or for the rates of reimbursement according to different levels of financing. This table provides a simple, feasible and applicable way for the CMS to decide the amount of financing and reimbursement.