2003—2012年吉林省新农合住院患者就诊及费用流向调查分析

Survey on flow direction of medical expenditure and hospital visit of new rural cooperation medical scheme in Jilin province during 2003—2012

目的:分析近10年来吉林省农村住院患者就诊与医疗费用的流向,探讨存在的主要问题并提出相应的对策。方法:通过2003—2012年吉林省新型农村合作医疗(新农合)信息系统中的统计报表收集资料,同时采用整群抽样方法,对2003—2012年参加新农合(简称参合)的住院患者进行调查,分析各级医院的住院人次、住院费用、住院补偿金额和次均住院补偿比等。结果:2003—2012年分流到县级以上和县级医疗机构的住院人次、住院费用和住院补偿费用逐年增加。2009年参合农民住院人次分流到县级以上、县级、乡级医疗机构的构成比分别为26.7%、46.3%和27.0%,2012年分别为30.4%、54.2%和15.4%。2009年住院费用分流到县级以上、县级、乡级医疗机构的构成比分别为57.0%、34.0%和9.0%,2012年分别为56.3%、37.9%和5.8%。2009年住院补偿费用分流到县级以上、县级、乡级医疗机构的构成比分别为49.2%、38.1%和12.7%,2012年分别为46.3%、45.6%和8.1%。2009年县级以上、县级、乡级医疗机构的次均住院补偿比例分别为32.2%、41.5%和52.6%,2012年分别为43.2%、63.1%和73.4%。结论:近10年来,吉林省参合农民的住院人次、住院费用和住院补偿费用分流到县级以上和县级医疗机构的比例均明显增多,分流到乡级医疗机构则逐年减少。次均住院补偿比在省内各级医院均逐年升高,乡级医疗机构的次均住院补偿比最高。

Objective To probe into the major problems and propose the corresponding countermeasures through analyzing the flow direction of the hospital visit and medical expenditure of new rural cooperation medical scheme （NRCMS） in Jilin province. Methods The 2003--2012 data from the statistical information system of NRCMS in Jilin province was used to conduct the statistic analysis. A cluster sampling method was used to investigate NRCMS inpatient, about person-time, medical expenditure, hospitalization reimbursement and rate per time in various hospitals. Results During ten years from 2003 to 2012, the rate of inpatients, medical expenditure and reimbursement to county-level or higher-level medical institutions increased year by year. The constituent ratios of the number of inpatient in medical treatment institution above county level, at county-level, and at township level were 26.7%, 46.3%, and 27% in 2009 ; and were 30.4%, 54.2%, and 15.4% in 2012. The constituent ratios of medical expenditure were 57%, 34%, and 9% in 2009; and were 56.3%, 37.9%, and 5.8% in 2012. The constituent ratios of hospitalization reimbursement were 49.2%, 38.1%, and 12.7% in 2009; and were 46.3%, 45.6%, and 8.1% in 2012. The average hospitalization reimbursement rates per time were 32.2%, 41.5%, and 52.6% in 2009, and were 43.2%, 63.1%, and 73.4% in 2012. Conclusion In the last decade, the rate of inpatient, medical expenditure and reimbursement to county level or higher level medical institutions increased significantly. However, the rate of township hospitals reduced year by year. The average hospitalization reimbursement rate per time in Jilin province increased year by year, and the rate of township hospitals was the highest.