西藏农牧区医疗制度现状和建议

Situation and Solution of Medical Care System in Tibet Farmland and Pasture

目的分析西藏农牧区医疗制度的政策演变、现状和运行效果,发现存在问题并提出建议。方法使用定性和定量分析方法,定性分析方法为文献研究和现场访谈,定量分析方法为描述性统计和对比分析。结果西藏农牧区医疗制度财政扶持力度较大,自2003年启动以来迅速推广,农牧民个人缴纳占基金总额的比例全国最低、报销水平较高,但也存在人均筹资排名逐渐落后、基金抗风险能力不足、医保经办能力建设不完善、按服务项目支付存在风险等问题。结论通过尽快建立动态筹资增长机制、提高基金统筹层次、加强经办能力建设、积极推动支付方式改革,提高对西藏农牧民健康的保障能力。

Objective To investigate the evolution,current situation and operating effect of the Cooperative Medical Care System in Tibet Farmland and pastoral areas, pick out the problems and seek to solutions. Methods The paper takes the qualitative and quantitative approaches,the former uses literature review and field interview,and the later uses the descriptive statistics and comparative analysis. Results The finance had a great support for the Cooperative Medical Care System of Tibet agricultural and pastoral areas, the policy was launched in 2003,and had a quickly promotion among Tibet famers and herdsmen. Tibet＇s famers and herdsmen had the nation＇s lowest ratio of individual payment in the healthcare fund pooling,and could have a comparatively high level of reimbursement,however,the growth of the fund was gradually dropped behind, the fund＇s capacity to resist risks was not enough, the management capacity-building of the fund was not perfect,and the Fee-for-Service Payment system had vulnerabilities in a way. Conclusion Establishing the dynamic financing mechanisms,raising the level of fund-pooling,enhancing the capability construction of management,and actively pushing forward the reformation of payment method as soon as possible,in this way we can upgrade the support capacity for health of the Tibet farmers and herdsmen.