潍坊市新型农村合作医疗总额定额付费方式改革与探索

Reform and Exploration about Total Quota Payment of the New Rural Cooperative Medical System in Weifang

目的：为有效控制医疗费用的快速上涨，探索支付方式改革。方法：研究介绍潍坊市新型农村合作医疗总额定额付费支付方式改革实施背景、原理和做法。监测分析其新型农村合作医疗运行数据的，验证改革的成效。结果：试点县医疗费用增长率比非试点县低17个百分点；政策范围内住院补偿比由实施前的38．9％（2008年）提高到71．7％（2011年）。提高了32．8个百分点：各县市区基金使用率波动幅度由实施前的90％～130％，稳定到实施后的（90％～95％。结论：总额定额付费支付方式，可以有效控制医疗费用过快增长，提高新型农村合作医疗基金使用效率，确保基金平衡。

Objective： To effectively control the excessive growth of medical expenditure increasing and explore the payment reform. Methods： It introduced the implementation, theory and practice of the total quota payment of the New Rural Cooperative Medical System（NCMS）, monitored and discussed the NCMS operation data and examined the reform effects. Results： The increasing rate of the medical insurance in pilot counties was 17% lower than the non-pilot counties. The implementation of the payment system of medical insurance increased from 38.9%（2008） to 71.7%（2011） for the theoretical reimbursement rate. In addition, it also reduced the NCMS funds fluctuation from 90%-130%（before the implemeutation） to 90%~95%（after the implementation）. Conclusion： Global prospective payment is a major mean to effetuvekt control medical expenditure increasing, increase the service efficiency of funds and ensure the balance of the NCMS funds