论加强需方管理、建立严格转诊制度的必要性:基于北京市涉农区县新型农村合作医疗基金超支原因的分析

Analysis on the Necessity of Strengthening the Demand Management and Establishing a Strict Referral System: Analyzing Factors for Overspending of New Rural Cooperative Medical Funding in 13 Districts and Counties of Beijing

目的:以北京市13个区县为例,对新型农村合作医疗基金超支因素进行深入分析,并提出相关合理化建议,以降低新型农村合作医疗基金超支的风险。方法:收集北京市13个区县2004—2011年新型农村合作医疗相关数据,并与各区县卫生局新型农村合作医疗相关人员进行访谈,了解新型农村合作医疗基金运行现状,深入分析基金超支原因。结果:从2004年以来,各区县新型农村合作医疗资金使用率逐年上涨,到2011年已有一半以上区县新型农村合作医疗基金超支,且基金超支趋势还在日益加重。结论:必须加强新型农村合作医疗基金管理,从加强需方管理、建立严格转诊制度、建立长效筹资机制、进行基金预警管理等方面入手防止新型农村合作医疗基金超支。

Objective：Taking the 13 districts and counties of Beijing as example, making thorough analysis on the factors for new rural cooperative medical system（NCMS） fund overspending. Reasonable suggestions were given to decrease the risk of NCMS fund overspending.Methods：Collecting the relevant data of 13 districts in Beijing from 2004 to 2011, making interviews with NCMS staff of Bureau of Public Health in different districts and counties, acknowledging the operation status of NCMS fund and making thorough analysis on the factors of NCMS fund overspending.Results：The NCMS fund utilization rates of each district have been risen by years since 2004. In 2011, more than half of the 13 districts suffered NCMS fund overspending, and the trend of fund overspending was increasing.Conclusion：It is needed to strengthen NCMS fund management, strengthen the demand management, establish strict referral system, build long-term financing mechanism and take fund early warning management, so as to prevent the overspend of NCMS fund.