山东省某县新农合住院病人支付方式及报销比例分析

A comparative analysis on payment and reimbursement of the inpatients with new rural coperative medical insurance in a county of Shandong Province

目的:了解参加新型农村合作医疗的住院病人医疗相关信息,分析新农合住院病人的支付方式与报销比例,讨论该县新农合支付方式改革现状。方法:应用统计软件SPSS19.0,对病人特征、疾病构成作描述性分析,运用非参秩和检验分析报销比例及其影响因素,对住院病人住院自付费用进行多因素分析。结果:该县参加新农合住院病人的年龄分布以1～5岁以及51～60岁年龄段为主。参合住院病人报销比例的均值为42.12%,中位数为41.94%,患者性别、年龄、疾病为影响报销比例的显著因素。患者的自付金额均值为1 509.81,占住院费用均值(2 301.217)的65.6%。患者自身年龄、住院天数为影响自付金额的两大因素。结论:该县为新农合支付方式改革试点县,参加新农合的住院患者的保障有所提升,但是报销比例仍然较低,患者需自付的金额占该县农民年均收入的17.2%,政府需加大监管力度控制好医疗费用,力求最大限度地减轻农民的疾病经济负担。

Objective To elicit the information about the inpatients with new rural cooperative medical insurance （NRCMI）, to analyze the payment and reimbursement of the inpatients and to discuss the progress of the new rural co operative medical payment reform in this county. Methods SPSS19.0 was used for statistical analysis. Nonparametric Wilcoxon rank sum test was used to analyze the reimbursement and its impact factors. Multiple linear regression was used to analyze the impact factors of the inpatients＇ out of pocket expenses. Results The age distribution of the inpa tients with NRCMI concentrates in 1-5 and 51-60. The average ratio of reimbursement of the inpatients with NRCMI is 42.12% ,and the median is 41.94%. Gender,age and disease are the significant impact factors of reimbursement. The mean of the inpatients＇ out-of-pocket expenses is 1509.81, accounting for 65.6 % of the mean of the total cost of hos pitalization （2301.217）. Age and the duration of hospitalization are the two main impact factors of outofpocket ex peases. Conclusion As the county has been taking the pilot reform for new rural cooperative medical payment, the healthcare security for the inpatients with NRCMI has improved, but the reimbursement rate is still low. The outof pocket expenses account for 17.2% of the average annual income of the farmers in this county. The government has to enhance the supervision of the medical expenses to maximize the reduction of farmers＂ financial burden of diseases.