海南省新型农村合作医疗参合农民乡镇住院“限费医疗”效果评价

Evaluation on the Impacts of “Fix out of Pocket” for Rural Patients Participated New Rural Cooperative Medical System in Hainan

目的:评价新型农村合作医疗新农合参合农民乡镇住院"限费医疗"政策对住院利用、就诊流向、患者经济负担及农合资金分配的影响,为完善相关政策提供依据。方法:数据主要来源于新农合报表、医院统计报表和住院病历等资料,评价指标主要选取住院人次、次均住院费用以及次均自付费用、农合资金分配比等。分析方法主要采用描述性分析和倍差法模型,并结合访谈资料对定量研究结果进行补充和解释。结果:该政策可能增加乡镇卫生院的住院人次数,对促进患者留在乡镇卫生院的作用有限;乡镇卫生院全病种次均住院费用和自付费用均下降;实施了限费医疗政策的万宁市高血压、肺炎的次均住院费用均无明显变化,而次均自付费用分别上升了11%和28%;对新型农村合作医疗资金分配无显著影响。结论:该政策对控制医疗总费用有积极作用,但对患者合理分流和农合资金分配作用有限。对病人住院经济负担的影响因病种而异,小病可能会增加自付费用。

Objective： To evaluate the impacts of the ＂fix out of pocket＂ payment policy on rural inpatients visits, visiting flow, patient economic burden and New Rural Cooperative Medical System（NCMS） fund altocation, so as to provide evidence lot related policies. Methods： The data mainly came from the NCMS claim data, medical records and hospital utilization data. The evaluation indexes were mainly selected from hospitalization number, average hospitalization expense, average self-payment and NCMS fund allocation raio, etc. Combined with the interview literature, descriptive analysis and difference in difference（DID） were applied to supplement and explain the result of qualitative research. Results： The policy might increase the number of inpatient visits, but had limited effect on keeping patients in primary medical institutions. The policy reduced the average medical expenses per inpatient visit at township hospitals on the whole. The average hospitalization expenses for hypertension and pneumonia had no obvious change in Wanning where the fix out of pocket policy was implemented. The average self-payment for these two diseases increased by 11% and 28%. which had no significant impact on NCMS fund allocation. Conclusion： The ＂fix out of pocket＂ policy had positive effect on controlling total health expenditure, while its allocation for reasonable flow and NCMS fund allocation was limited. The impacts for patients＇ payment differ in different areas. For mild cases, it mignt increase the out of pocket.