福建省新型农村合作医疗住院费用与实际补偿比影响因素研究

Study on Influence Factors of Hospitalization Expenditure and Compensation Ratio of NCMS in Fujian Province

目的分析福建省新型农村合作医疗(新农合)近8年的住院费用与实际补偿比,探讨其规律与主要影响因素。方法用SPSS11.5软件分析福建省2004～2011年住院补偿数据库,以logistic回归分析住院费用与实际补偿比的影响因素。结果随着筹资额增加,住院费用与实际补偿比呈上升趋势;补偿级别越高住院费用越高、实际补偿比越低;"较富"的地区住院费较高、实际补偿比较低。住院费用的影响因素主要是到县外住院和自付费用高;实际补偿比的影响因素主要是人均筹资额和范围外费用比例。结论建议加强基层医疗机构建设,提高服务能力与质量,适当扩大药品和诊疗目录,引导合理的病人流向;控制范围外诊疗费用,以降低医药费用、提高实际补偿比;制定政策应注意防止"穷帮富"倾向,引导基金向"较贫"地区转移。

Objective To analyze hospitalization expenditure （HE） and actual compensation ratio（ACR） of NCMS in Fujian and study influence factors. Methods The influence factor of HE and ACR in 2004-2011 databases were analyzed by SPSS ll. 5 and logistic regression model. Results HE and ACR were increasing with year/fund-collecting. The higher of hospitalization level, the lower of ACR and higher HE. Com- paring poorer areas, HE level was higher and ACR was lower in richer are- as. The main influence factors of HE were hospitalization out of county and high self-paying level. The influence factors of ACR were fund-collecting and non-compensatory ratio. Conclusion Enhancing hospitals at town- ship level, expanding basic drugs and treatments directory, controlling HE especially non-compensatory expenditure and preventing ＂poor help rich＂ should be carried out to promote the development of NCMS in Fuiian.