新型农村合作医疗住院补偿流向分析

Flow of inpatient compensation of new rural cooperative medical system

目的：了解宁夏新型农村合作医疗住院补偿流向。方法：采用系统随机抽样的方法,随机抽取宁夏的平罗县和隆德县2005年1月至2006年12月新型农村合作医疗住院补偿病人费用资料,利用国际系统疾病分类（ICD-10）对疾病分类,从补偿人数、补偿费用及病种3个角度分析住院补偿流向。结果：两县新型农村合作医疗住院补偿均以县级医院为主,但隆德县外医院住补偿费用、补偿人次数占比例较高,以较重、较复杂的慢性病为主;平罗县以0－岁、20－岁年龄组为主,隆德县以20－岁、40－岁龄组为主;顺产、剖宫产、阑尾炎、疝气、胆囊炎、胆结石、骨折病种较为常见。结论：山区基层医疗机构不能满足参合农民就医需求,农民疾病防范意识不高。应加强基层医疗机构建设,充分利用新型农村合作医疗家庭账户资金促进健康教育,增强健康意识;对较常见、治疗效果容易保证、质量容易控制的病种实施单病种付费。

Objective To explore the flow of inpatient compensation of new rural cooperative medical system in Ningxia so as to give some instructive views for improving the operation mechanism of new rural CMS in Ninxia province. Methods We chose Pingluo county and Longde county,the first pilot counties of new rural CMS in Ningxia, as our research object and collected the data from January, 2005 to December, 2006 of CMS compensation for inpatients in these two counties by using systemic random sampling. Then diseases were categorized according to International System Disease Classification （ICD--10） and flow of CMS compensation for inpatients was analyzed from the aspects of number of patients, amount of compensation and type of disease. Results Inpatients treated in county hospitals are the main CMS compensation objects,but in Longde county,the number of inpatients treated in other hospitals and the compensation amount for them are higher ,mainly of serious and complex chronic diseases. In Pingluo county patients who get compensation are mainly in age groups of zero and twenty while in Longde county they are mainly in age groups of twenty and forty. Such diseases as appendicitis,hernia and cataract etc are common. Conclusion Medical institutions in mountanous areas can not meet the medical demands of farmers there and farmers are not aware of the importance of disease prevention. So we should raise the amount of funding, strengthen the building of primary medical institutions, make full use of domestic funds to promote health education and enhance their health awareness. The diseases which are common, easily treated and controlled can be included in the paying mode of single disease.