新农合制度运行现状分析——基于6省14县的调查

Analysis on operational status of the New Rural Cooperative Medical Scheme: Based on the field survey in 14 counties of 6 provinces

目的：比较分析新农合住院服务利用、补偿、基金等方面运行情况，了解各地新农合的进展。方法：东、中、西部各选2个省，每个省随机选择2个县（江苏、广西抽取3个）作为样本县，对14县新农合基金和住院服务情况进行描述性分析和比较分析。结果：2012和2013年平均筹资水平分别为300和350元左右；利用县外医疗机构住院服务比例较高，I县甚至超过40％；除江苏、安徽外，其他四省住院补偿受益率超过10％；除福建外，住院实际补偿比超过50％；各县次均住院费用差异较大，2013年上涨明显；个人自付次均住院费用占农民人均纯收入的比例各县不同，部分县2013年有所下降；流向县外医疗机构的基金比例较高，G县甚至超过50％；当年基金多发生赤字，基金累计结余率在1％～2％之间。结论：新农合筹资水平较低，个人筹资责任较轻。住院服务利用结构不尽合理。住院实际补偿比提升乏力，群众医疗费用负担缓解不明显。基金可能存在监管乏力，且风险较高。

Objective： To Compare the operational status of the New Rural Cooperative Medical Scheme（NCMS） in 14 Counties of 6 provinces. Methods： Two provinces were selected from eastern, central and western areas respec- tively and then two counties were chosen randomly from each province, but each of Jiangsu and Guangxi Provinces pro- vided 3 to reach the sample number of 14 counties. Excel 2007 was used for descriptive and comparative analysis of fund and in-patient service for NCMS. Results： The average funding standard was about 300 and 350 Yuan for 2012 and 2013. Hospitals outside county were frequently used and the ratio was over 40% in county I. Except Jiangsu and An- hui, the rate of enrollees who get compensation for inpatient service was over 10% and the actual compensation rate more than 50%, Fujian being an exception. Average hospitalization costs per time were different among counties and significantly rose in 2013. The ratio of out of pocket inpatient service expenses to the net rural household income was diverse among counties and it declines in some of them in 2013. The rate of fund for hospitals outside county was high and that of G counties was more than50%. The fund surplus rate was negative in that same year and was accumulatively ranging between 1 and 2%. Conclusions：The NCMS financing level was low and the personal financing responsibility was lighter; the enrollees didn＇t contribute enough. In-patient service utilization structure was not rational in different level hospitals. The actual compensation rate for inpatient service didn＇t increase a lot and the medical expenses burden didn＇t alleviate apparently. The funds supervision was weak and it probably leaded to a high risk fund deficit.