不同筹资与补偿方案下新农合运行情况分析

Operational analysis of new rural cooperative medical scheme under different reimbursement circumstances

目的:探索不同筹资与补偿政策对新农合运行的影响。方法:利用2008年至2011年广州番禺区所有得到新农合报销补偿的185 426份住院相关数据,分析新农合的住院人次分布、次均住院费用以及实际补偿比。结果:不同赔付年度乡镇卫生院与区县级医院住院人次均约占总住院人次的90%,地市级以上医院约占10%。不同赔付年度中,各类医院的次均住院费用与实际补偿比的差异均有统计学意义。结论:不同筹资与补偿方案下,新农合住院的受益情况相对较稳定,随新农合筹资水平的提高,各级医院住院补偿均有所上升,参合人受益情况有所提高。

Objective To investigate the operation of new rural cooperative medical scheme for hospitalization under different reimbursement circumstances. Methods A database of all hospitalizations reimbursed from the New Rural Co- operative Medical Scheme between January 2008 and December 2011 in Panyu district of Guangzhou covering 185,426 discharges was adopted to analyze the personal time of hospitalized patients, the average cost of each hospitalization, and the actual reimbursement rate. Results The proportion of hospitalizations in township and county hospitals was approxi- mately 90% ,and the proportion of hospitaiization in prefecture hospitals was approximately 10%. The differences of the average costs of each hospitalization and the actual reimbursement rates in different paid year were statistically sig- nificant among different hospitals. Conclusions The benefit level of new rural cooperative medical scheme under different reimbursement circumstances remains stable. With the increase in funding level, the hospitalization compensation and benefit level of rural residents increased.