“按人头支付”改革对参合农民住院医疗费用的影响研究

Evaluation Study on the Effect of Participating Farmers' Inpatient Medical Expense after the implementation of Capitation Reform

目的:评价新型农村合作医疗实施"按人头支付"改革对参合农民住院医疗费用控制的效果。方法:收集浦东新区"按人头支付"改革实施前、后的新型农村合作医疗运行数据以及5.1万住院人次的就诊费用、补偿金额等数据并进行比较分析。结果:支付方式改革后,对于控制住院费用的过快增长有一定作用,其中以镇级机构效果最为明显。结论:针对二、三级医院的控费配套措施以及评价转诊服务合理性等方面仍有待深入研究。

Objective： To evaluate the effect of controlling the inpatient medical expenses for participating farmers after the implementation of this reform. Methods： It collected the new rural cooperative medical system（ NCMS） operational data before and after the implementation of capitation reform. The data included 51 000 inpatient records about treatment cost, the amount of compensation and other data from 2011 to 2012. Results： After the capitation reform, the excessive growth of inpatient medical expenses obtained a certain degree control, especially the effect of community health institutions is most obvious. Conclusion： Further studies on how to motivate the staff in secondary and tertiary hospitals to control medical expense actively are needed.