新型农村合作医疗统筹补偿模式分析

Analysis on Reimburse Modes of New Type Rural Cooperative Medical System

完善新型农村合作医疗统筹补偿方案,是新型农村合作医疗制度建设的基础和核心。根据试点经验,新型农村合作医疗统筹模式主要有大病统筹加门诊家庭账户、住院统筹加门诊统筹和大病统筹三种模式。而这三种模式的选择实质上就是要处理保大与保小的关系,在保小中是选择家庭账户还是选择门诊统筹更有效的问题。完善新农合的统筹补偿模式,应根据制度补偿的目标和原则,科学调整统筹补偿方案,完善统筹补偿政策,不断提高新农合的受益水平和扩大受益面。

The improvement reimburse modes of new type rural cooperative medical system （CMS） is the basis and core of CMS. According to the pilot experience, there are three kinds of reimburse modes,such as the model of medical saving account and planning inpatient cost as whole, the model of planning inpatient cost and outpatient cost as whole, the model of planning only inpatient cost as whole. In fact,the choice of three models is to deal with insurance large and small, in which we should choose medical saving account or inpatient cost and outpatient cost as whole more effectively. To improve the reimburse modes of CMS, we should adjust the reimburse programmes and policy and continually enhance the benefit coverage and level of CMS.