科学设计一定筹资下的补偿方案:新型农村合作医疗保险方案研制关键技术实证分析之二

The empirical analysis of the New Rural Cooperative Medical System(Ⅱ):design of compensation policies

目的 ：运用实际数据,检验补偿方案的研制思路与方法的科学性和可操作性。方法 ：以样本地区2011年住院补偿数据为例,以新型农村合作医疗决策平台为工具进行方案研制。结果 ：以福利风险型方案研制为例,（1）按照80%补偿比,消除因病致贫风险共需筹资4 163.96万元;（2）以就医经济风险约等于1时所对应的医疗费用设定起付线为600元,以人均收入8倍为标准设定封顶线为120 000元,观察住院人群的就医概率、经济风险分布状况,将费用段分为600~、3 000~、10 000~和22 000~四段,并分别设定相应的补偿比;（3）按照上述补偿方案,基金60.53万元,实现了＂收支平衡,略有结余＂。结论 ：补偿方案研制的思路和方法是科学合理、可操作的。

Objective：To test the scientificalness and operability of the ideas and methods of developing reimbursement plans.Methods：This article took data of hospitalization reimbursement from sampling areas in 2011 as an example and used the new rural cooperative medical decision-making platform as a tool to develop the plans.Results：This study took welfare-risk plans as examples.（1）Totally 41 639 600 yuan should be funded to eliminate medical impoverishment risks at 80% ratio of reimbursement;（2）The study set 600 yuan as deductible that corresponds to the average risk of the participants.It cut the medical costs into four segments（600~,3 000~,10 000~,22 000~）and set ratio of reimbursement respectively at terms of the probability of hospitalization and the distribution of financial risk of the hospitalized group;（3）Based on the above reimbursement plans,the goal of balance of medical insurance fund with 605 300 yuan of capital funds was achieved.Conclusion：The ideas and methods of the development of reimbursement plans are scientific and operative.