新农合住院支付方式改革现状及问题分析

The current situation and problems of hospitalization payment system in New Rural Cooperative Medical Scheme

在深化医药卫生体制改革过程中,新农合进行了较大范围的住院支付方式改革探索,并形成了三种主要方式:单病种限额管理、单病种定额付费和按床日付费。目前的支付方式改革在控制医疗费用不合理上涨方面已取得一定成效;但同时也存在一些问题,表现为控费效果不明显、医疗质量监管和评估体系设计不足、付费标准制定不科学,医疗机构补偿不到位等。对此,提出建立住院混合支付方式、加强质量监管、探索科学的付费标准制定方法、完善补偿机制、建立双向转诊制度的对策建议。

In the process of deepening the medical and health system, a large range of exploration have been made in terms of the hospitalization payment system of New Rural Cooperative Medical Scheme （NRCMS） and have been formed three main models： fixed price for single disease; limited price for single disease and per-diem reimbursement. Although the current reform have been controlled the quickly unreasonable rise of the medical expenditure in some extend, however, some problems are still existing. For instance, the effect of cost control is not effective ; the design of medical quality is not sufficient, the payment system is not scientific; and the compensation to hospital is not enough. Basing on analyzing the above problems, some relevant recommendations are made in terms of establishing the mixed hospitalization payment system; strengthening the quality control; exploring the scientific payment setting method; improving of the compensation mechanism as well as building the referral system.