武汉市新农合大病保险实施效果评价

Evaluation of purchasing critical illness insurance under new rural cooperative medical system in Wuhan

目的:提高新农合的科学运行与管理。方法:总结武汉市新农合大病保险工作的做法与成效,对武汉市新农合大病保险的实施效果进行评价,分析存在的问题,提出解决措施。结果:2014年武汉市全面启动了新农合大病保险工作,通过加强资金管理、规范基础工作、推进合署办公、加强政策宣传及稳步开展好理赔服务等措施,大病保险赔付工作进展顺利,参合农民住院实际补偿率显著提高(P<0.01);基金支出以普通住院补偿为主;人口规模小的区出现基金透支,但由于采取了市级统筹政策,化解平衡了区域性风险。结论:新农合大病保险工作有效缓解了农民"看病难、看病贵"问题,要完善好大病保险工作,需进一步提高统筹层次,加强政策宣传,推进合署办公,加强赔付监管。

Objective To sum up the experience of purchasing critical illness insurance under new rural cooperative medical system in Wuhan, to analyze the existing problems,and to provide the solutions. Results Program of critical ii1- ness insurance under new rural cooperative medical system was started up in Wuhan in 2014. By strengthening the fund management,regulating basic work, promoting the co- working, enhancing publicity and developing the insurance claims service, the work goes well. The ratio of participating farmers＂ actual hospital compensation increased significant ly（P^O. 01）. The hospitalization compensation occupies the main part of fund expenditure. Fund overdraft was found in lesser populated area, but due to the municipal planning policies, the regional fund risk was prevented. Conclusions Purhasing critical illness insurance under New Rural Cooperative Medical System efficiently relieves the burden of medical costs on the farmers with serious illnesses. We need to raise the level of overall plan,enhance publicity,promoting coworking and strengthen the monitoring on insurance payment services.