卫生部门与社保部门对新型农村合作医疗的管理模式比较

Comparison of Modes of New Rural Cooperative Medical Management

目的探索新农合2种管理模式在保障制度设计、资金管理方式、监管措施等方面的差异,比较2种模式下新农合基金控制情况及医疗保障效果。方法采用典型抽样调查法,分别选2个地区作为2种模式的代表地区,调查内容包括管理组织结构、补偿制度、对医疗机构医疗基金使用的管理及行为的控制。结果从体制上,社保部门具有管办分离的优势,但卫生部门的费用控制能力依然较强,其在熟知医院发展的基础上,能利用各种制度、手段、奖惩措施使新农合良性运行。从管理机制来看,卫生部门能兼顾医院的发展,提高保障水平;社保部门更注重基金的安全运行。但两者的管理效果Mann-Whitney U=249.00,P>0.05说明不具有统计学差异。结论 2种模式各有利弊,模式最终将趋于统一,但关键点还应关注是否有效保障参合农民的基本医疗权益。

Objective To explore the differences between two modes of new rural cooperative medical system in some aspects,such as the design of management,financial management and regulatory measures,compare the situation of medical care funds control and the effect of medical security of the new rural cooperative medical system under these two modes.Methods Two regions were selected as representative areas of two models by typical sampling method.The investigation included management structure,compensation system,management of health funds use and behaviors control of the medical institutions.Results In terms of system,the social security branch have the advantage of management office separation,but the health department also have the power of cost controlling ability.Based on the management mechanism,health sector can cover the development of hospitals and improve security level;and social security department pay more attention to the security of fund operation.However,the effectiveness of two managements has no statistical significance.Conclusion Two patterns have both advantages and disadvantages,but will eventually be integrated.It is critical to concern that whether the farmer＇s basic medical rights and interests got guarenteed.