湖北省县域医疗保险基金运行情况分析

Analysis on Medical Insurance Fund Operating Status in Counties of Hubei

目的:分析湖北省所有64个农村县级行政区划新农合和医保基金的总体运行情况,为湖北省医疗保险政策完善提供参考。方法:资料来源于湖北省各级卫计委、人社、医疗机构填报的表格;将各县域依照经济发展水平分为三类,分析筹资水平,支出、结余情况,患者就医流向,补偿水平。结果:湖北省县域新农合、城镇职工与居民医保参合人数稳定;筹资总额、累积结余呈增长趋势;县域外就诊比例保持平稳,三类地区略高;住院实际补偿比和经济发展状况呈正相关。结论:湖北省县域内三项基金总体运行状况良好,城镇医保基金运行状况优于新农合基金;各项基金的筹资水平增长迅速,然而实际补偿比未见明显提高。

Objective： To analyze the operating status of new rural cooperative medical system（NCMS） and medical insurance fund in all 64 county level administrative divisions of Hubei so as to provide references for Hubei medical insurance policy making. Meth- ods： Data was collected from Health and Family Planning Commission, Department of Human Resources and Social Security and Medical Institutions at different levels of Hubei. According to economic development situation, all included counties were divided into three categories to analyze the financing level, expenditure, the balance situation, patient hospitalization flow and compensation level. Results： The number of insured in these three schemes was stable. Total financing and accumulated balance showed increasing growth, the outside county treatment proportion was stable, type llI region was slightly higher. The actual hospital compensation ratio and economic development status were positively correlated. Conclusion： In general, all three schemes in counties of Hubei were in good condition, urban medical insurance fund operation condition was better than the rural. Each fund＇s financing level was growing rapidly, but the actual compensation level were not obviously improved.