基于需方角度的新型农村合作医疗“按人头支付”实施效果评价

The Effectiveness Evaluation of Capitation Reform in the New Rural Cooperative Medical Scheme Payment System Reform Based on Demanders' Perspective

目的:本研究从需方角度分析新型农村合作医疗按人头支付改革实施的效果,为进一步完善"按人头支付"改革提供依据。方法:采用描述性分析比较2011年和2012年按人头支付改革前后参合农民受益面、受益程度、医疗费用负担及抗风险能力等指标;采用问卷调查研究浦东新区33家社区卫生服务中心参合农民改革前后的满意度情况。结果:新型农村合作医疗按人头支付改革后,参合农民受益率和住院受益程度在一定程度得到提高,参合农民费用负担及其抗疾病风险的能力得到一定程度的改善和提高,同时按人头支付改革的推进并降低参合农民的满意度。结论:按人头支付改革在一定程度上降低了参合农民的就医经济风险,改革的长期效果有待继续研究深入。

Objective： It aims to evaluate effectiveness of capitation reform in NRCMS in Pudong New Area from demanders＇ perspective, and to provide more basis for implementing the reform. Methods： By collecting indicators＇ related data of the benefit coverage, health service utilization, reimbursement degree, expense burden and resistance capabilities of participant in pilot areas, and doing statistical analysis; a questionnaire was designed to investigate the satisfaction of patients in 33 community health service centers and the survey was conducted twice in the same month in 2011 and 2012 for comparison. Results： After the implementation of the capitation, the benefit ratio and hospitalization benefit levels were improved, and the outpatient service utilization was guaranteed. The resistance capabilities were enhanced. Meanwhile measures to promote the capitation reform did not affect the satisfaction of participant. Conclusion： The capitation reform reduce the medical economic risk of participating farmers, the long-term effect of the reform still needs further study.