甘肃省卫生Ⅺ项目新农合住院患者分流状况

Allocation status of inpatients in new rural cooperative medical system in Health Ⅺ Project of Gansu Province

目的研究甘肃省卫生Ⅺ项目试点县新农合住院患者分流状况,找出存在的问题及原因,为完善新农合引导合理分流的机制、引导农民进行理性就医提出相应的对策建议。方法收集甘肃省新农合经办机构试点县2007—2013年《甘肃省新型农村合作医疗运行情况分析年报表》及相关文件资料进行统计分析。结果甘肃省县级及县级以上医疗机构住院人次和住院补偿资金占比逐年上升。2007—2013年的新农合住院人次,县级医院所占比例从46.21%上升至55.29%,县级以上医院所占比例从8.97%上升至27.59%,而乡镇卫生院所占比例下降了10.47个百分点;住院补偿资金,县级医院所占比例波动在40%~50%范围内,县级以上医疗机构所占比例波动在32%~42%,乡镇卫生院所占比例下降了11.52个百分点。结论甘肃省新型农村合作医疗并未起到引导住院患者合理分流的作用,新农合住院患者分流不合理现象严重,需进一步加强政策改革及监管,引导农村患者合理分流,使农村医疗服务资源得到合理配置,让农民获得更好的医疗服务。

[Objective] To analyze the allocation status of inpatients in new rural cooperative medical system （NCMS） of World Bank/DFID Supported Health XI Project in Gansu Province, identify existing problems and causes, and put forward countermeasures and suggestions for improving the mechanism of reasonable allocation of NCMS and guiding farmers to rationally choose medical treatment.[Methods] The annual reports on the operation of NCMS in Gansu Province from 2007-2013 were collected from the pilot counties of NCMS, the data and relevant documents were statistically analyzed. [ Results ] The allocation status of NCMS in Gansu Province was unreasonable, which was presented as the proportions of inpatients and hospitalization compensation were rising gradually in medical institutions at county-level or above. For the inpatients of the NCMS, the proportion in county-level hospitals increased from 46.21% to 55.29%, and the proportion in hospitals above the county level increased from 8.97% to 27.59%, while the proportion in rural township hospitals decreased by 10.47 percentage points at the same time. As for the hospitalization compensation, the ratios of county-level hospitals fluctuated in the range of 40%-50%, and the ratios of hospitals above the county level were between 32% and 42%, while the ratios of rural township hospitals decreased by 11.52 percentage points.[ Conclusion ] The new rural cooperative medical system does not play a role in guiding the rational allocation of inpatients in Gansu Province, and there is a serious irrationality in allocation of NCMS inpatients. It is necessary to further strengthen policy reform and regulation and guide the rational allocation of rural patients, to reasonably allocate the rural medical service resources and provide the better medical services for farmers.