玉溪市不同医疗机构及病种新农合住院经济负担及补偿分析

Study on the direct economic burden and the compensation situation of the new rural cooperative medical system at different medical institutions and diseases in Yuxi city

目的了解玉溪市农村居民疾病直接经济负担情况,为提高新农合政策保障水平、最大限度减轻农村居民疾病直接经济负担提供参考。方法收集玉溪市2005—2012年新农合329 636例住院病例资料信息,用SPSS17.0软件进行统计分析。结果玉溪市329 636例新农合报销的住院直接经济负担平均1 819.7元/例。在医疗机构上:中位人均直接经济负担由大到小排列分别为:省级,市级、民营、县级、乡镇级;中位人均补偿比为49.1%,补偿比从大到小分别为:乡镇级医疗机构、民营、县级、市级、省级,经济负担和补偿情况排名在医疗机构上基本呈反向分布。在不同疾病类型上:中位人均直接经济负担从大到小排名为:恶性肿瘤、脑血管病、内分泌营养和代谢病、损伤及中毒、神经系病、心脏病、消化系病、呼吸系病、传染病及其他。不同疾病就诊农村居民住院直接经济负担补偿中,中位补偿比从小到大分别为恶性肿瘤、泌尿生殖系病、损伤及中毒、传染病、神经系病、内分泌营养和代谢病、呼吸系病、脑血管病、心脏病及其他。结论新农合在一定程度上降低了农村居民疾病直接经济负担,在有限的卫生资源条件下,对不同级别医疗机构及不同疾病的补偿应该综合考虑,探索更加合理的补偿制度。

Objective To explore the direct economic burden of diseases in rural residents,and to provide the referencefor the improvement of the level of medical system and to reduce the economic burden for peasantry. Methods The 329 636 hospitalized cases＇ information was collected in a new rural cooperative medical system during 2005-2012. SPSS 17.0 softwarewas used to analyze the data. Results The average of direct economic burden was 1 819.7 yuan/case. The median directeconomic burden at medical institutions from high to low rank were the provincial level,the municipal level,the private level,the county level, and the town level,respectively. And the median rate of percapita compensation was 49.1%. The median rateof compensation for medical institutions from high to low rank were the town level,the private level,the county level,themunicipal level,and the provincial level,respectively. There was an inverse relationship between the rank of the economicburden of medical institutions with the median rate of compensation. The direct economic burden of different diseases fromhigh to low rank were the malignant tumor,cerebrovascular disease,endocrine nutritional and metabolic disease,injury andpoisoning,nervous system disease,heart disease,digestive disease,respiratory disease,infectious disease and others. Themedian compensation rate of different diseases from low to high rank were the malignant tumor,genitourinary system disease,injury and poisoning,infectious disease,nervous system disease,endocrine nutritional and metabolic disease,respiratorysystem disease,cerebrovascular disease,heart disease and others. Conclusion The new rural cooperative medical systemcould reduce the direct financial burden of diseases for rural residents. The compensation should be comprehensivelyconsidered under the limited health resources in different levels of medical institutions and diseases,ultimately,a morereasonable system of compensation be explored.