丹江口市新型农村合作医疗住院补偿情况分析

Analysis for inpatient expenses reimbursement under New Rural Cooperative Medical System in Danjiangkou

[目的]分析丹江口市2003年～2008年新型农村合作医疗统筹基金使用状况及住院补偿情况。[方法]对2003年～2008年丹江口市新型合作医疗统筹基金的有关数据进行分析。[结果]在前后六个运行周期内,统筹基金使用率最高为87.99%;2003年～2008年平均每年大约有45%、41%的社会统筹基金分别流向乡镇卫生院和县级医疗机构,各级医疗机构中乡镇卫生院补偿人次最多。2008年统筹基金流向乡镇卫生院、县级医疗机构、县级以上医疗机构的比重分别为54.14%、34.98%、10.88%。2003年～2008年乡镇卫生院、县级医疗机构的实际住院补偿比呈现逐年增加的趋势。[结论]需要提取风险准备金来防范风险;采用多种措施合理化各级医疗机构的住院补偿比结构。

Objective To learn about situation of the inpatient expenses reimbursement and the utilization of Social Unified Raising Fund （SURF） of New Rural Cooperative Medical System （NRCMS）. Methods To analyze the data about SURF in Danjiangkou from 2003 to 2008. Results In the six years, the highest proportion to use the pool funds was 87.99%. On average, annually 45.00% and 41.00% SURF were used for compensation on medical expenses in the township and county hospitals respectively. Each year the reimbursement fund covers more individuals visiting the township hospitals compared to other level facilities. In 2008, the reimbursement proportions of SURF for facilities at township, county and above county levels were 54.14%, 34.98% and 10.88% respectively. The compensation proportions for inpatients in township and county hospitals increased each year. Conclusion It may be necessary to prepare the risk fund to prevent the possible risk and figure out the proper inpatient compensation proportions at various level facilities by conducting feasible measures.