安徽省基本药物改革前后新农合住院病人流向与医疗费用比较

Comparative analysis on inpatient flow and medical expenditure of New Rural Cooperative Medical Scheme before and after the essential medicines system reform in Anhui province

目的:比较分析安徽省基本药物改革前后新农合住院病人流向和医疗费用变化情况。资料与方法:抽取安徽3个县新农合数据,并对3个县卫生行政部门和6个乡镇卫生院的关键知情者进行访谈。结果:基本药物制度改革以后,样本地区参合人员总住院数量下降了13.80%,其中乡镇卫生院下降了55.07%,县级医院和县级以上医院分别上升了12.17%和20.81%;总的次均住院费用和次均住院自付费用分别增长了29.32%和32.07%,住院总费用增长了11.48%。结论:基本药物制度改革以后,新农合病人在乡镇卫生院住院大幅减少,县级及以上医院住院增长明显;乡镇卫生院次均住院费用得到控制,但由于县级以上医院次均住院费用和住院人数增长,导致住院总费用上涨、参合病人的实际补偿水平下降。

Objective： This paper compares the status quo of the patient flow and medical expenditure of inpatients under the New Rural Cooperative Medical Scheme （NRCMS） before and after the essential medicines system reform. Methods： Facility data were collected from a sample of 3 counties and 6 township health centers in Anhui province, together with in-depth interviews with key informants from the health facilities. Results： after the essential medicines system reform, the total amount of inpatients covered by NRCMS in the sampling area decreased by 13.80%; the number of inpatients at township health centers decreased by 55.07%, and the increase rate of inpatients at county hospitals and tertiary hospitals were 12.17% and 20.81% respectively. The average expenditure per admission of hospitalization, the average out-of-pocket expenditure per admission of hospitalization, and the total expenditure of hospitalization increased by 29.32%, 32.07% and 11.48% respectively. Conclusions： After the essential medicines system reform, the amount of inpatients of NRCMS in township health centers decreases; on the contrary, more inpatients go to hospitals at county or above level. The expenditure per admission of hospitalization at township health centre has been controlled. However, because the expenditure of hospitalization and the amount of inpatients at county and higher level have significantly increased, the total expenditure of hospitalization soars. As a result of this, the actual average reimbursement rate for inpatients of NRCMS descends.