银川市城镇居民医疗保险筹资水平及补偿方案测算研究

The Research on the Financing Level and Compensation Program about Medical Insurance for Residents of Yinchuan City

目的探索银川市城镇居民医疗保险的筹资水平以及住院费用的起付线、封顶线和补偿比的测算。方法采取等容量多阶段分层随机抽样方法从银川市各社区抽取样本对居民进行入户调查,调查居民的参保意愿及筹资意愿;对银川市不同等级医院的城市自费住院病人的住院总费用进行统计,利用测算公式,并结合银川的实际情况,测算出银川市城镇居民参保的筹资标准及住院费用的起付线、封顶线及补偿比。结果根据银川市经济发展水平和城镇居民筹资意愿及承受能力,确定的筹资标准为年人均200元,参保居民在市属二级医院、三级医院及省级医院住院费用起付线分别设定为300元、400元、700元,封顶线分别设为10000元、30000元、40000元,住院补偿比分别设为55%、45%、35%。结论根据居民筹资意愿、支付能力及实际测算,在银川市实行城镇居民医疗保险是切实可行的。

Objective To probe the financing level on medical insurance for residents of Yinchuan City and measurements and calculations of the starting point, the capping point and replacement ratio concerning the cost of hospitalization. Methods By means of equal capacity, multi -phases, hierarchical ordering random sampling, the sample residents from various communities in Yinchuan City were surveyed house to house to inquire about the residents＇wishes to be insured and their attitudes to financing. The total cost of the inpatients at their own expense from different hospitals in Yinchuan City was counted. Using calculating formula, based on the actual situation of Yinchuan City, the financing standards of residents to be insured and the starting point,the capping point and replacement ratio were measured and calculated. Results In accordance with the economic development of Yinchuan City, the attitudes of the residents to financing and their capacity, the established f＇mancing standard was ￥ 200 per person per year;the starting point of hospitalization fees for inpatients of insured residents was as follows： ￥ 300 for second class hospitals; ￥ 400 for third class hospitals; ￥ 700 for provincial hospitals. The capping point of hospitalization fees for inpatients of insured residents was as follows： ￥ 10000 for second class hospitals; ￥ 30000 for third class hospitals; ￥ 40000 for provincial hospitals. The replacement ratio was 55% ,45% and 35% respectively. Conclusion With regard to the residents＇ attitude to financing, their payment capacity and calculation, it is feasible to practice medical insurance for town residents in Yinchuan.