新型农村合作医疗医疗费用控制实证研究(二)--新型农村合作医疗道德风险发生的主要环节

New Rural Cooperative Medical Scheme Medical Cost Control Empirical Study Series(2)——Where the Moral Hazard Occurs in New Rural Cooperative Medical Scheme

从实证的角度,研究新型农村合作医疗农村定点医疗机构道德风险,即不合理医疗费用发生的环节和特点,用"病例—对照"方法选取安徽省2006年6个试点县与6个非试点县的县、乡级医疗机构的子宫肌瘤与脑血栓作为研究病例,用同行评审法判出不合理医疗费用。结果显示:(1)在实施新型农村合作医疗的县,不论是县级还是乡级医疗机构,药费都是最容易发生不合理费用的费别;(2)为规避经办机构的监管,试点县的县、乡级医疗机构不合理费用的发生较分散,即不规范行为较隐蔽。基于研究结果,文章提出不合理费用控制策略:(1)采取以建立基本药物制度为核心的综合措施改变医疗机构"以药养医"的局面;(2)实行支付方式改革,探索以总额付费为核心的混合支付方式,把费用控制主体转移到定点医疗机构。

This article demonstrates the moral hazard of New Rural Cooperative Medical Scheme in the rural designated medical institutions by empirical analysis, namely the links and characteristics of the unreasonable medical cost. With the method of case-control, we selected six pilot counties in Anhui province as the case group, another six non-pilot counties as the control group. And then we drew hysteromyoma and cerebral thrombosis as cases to judge the unreasonable medical cost by the Peer Review method. The research found that： （1）charge for medicine was the most vulnerable cost category--for county and for township medical institutions; （2）to circumvent the supervision of agencies, the designated medical institutions dispersed the unreasonable costs, that is, the irregularities were subtle. Based on the findings, the article suggests that： （1） to build the Basic Drug System as the core of comprehensive measures to control the unreasonable medicine expenses; （2） to reform the methods of payment and explore the global budget-oriented hybrid methods of payment, and transfer the duty of medical cost control to the designated medical institutions.