新型农村合作医疗供给行为的影响与对策研究——基于次均费用限额视角

Impact of New Rural Cooperative Medical Supply Behavior and Its Countermeasure——based on the Perspective of Average Fee Limit

支付方式改革的目标能否实现,取决于它能否改变医疗服务提供者行为。利用江西省某医院2015年新农合儿科住院数据断点回归方法表明,新农合次均费用限额政策使得儿科住院患者药品费用下降10.8%,但医疗诊断费用提高了8%,对总体医疗费用和农民自付费用影响不显著。研究结论显示,新农合总额预付制度在有效控制医疗费用总额增长的同时,将支付压力转移给了参合农民,并加大了医疗市场不平等。新农合制度改革应在短期内加强对非药品费用监管,长期要重构供给方收益函数。

The realize of payment reform depends on whether it can change the medical service supplier＇s behavior. This paper uses Jiangxi new rural cooperative medical system inpatient data in 2015, the regression discontinuity method indicates that the average fee limit has reduced the pharmacy fee by 10.8%, but the medical diagnosis charge increased by 8%, the im- pact on overall medical charge and farmers＇ out-of-pocket payment is not significant. The conclusion shows that the new ru- ral cooperative medical system gross prepayment system can control the gross medical charge growth effectively, transfer the payment pressure to participant farmers, and enlarge the inequity of medical market. The new rural cooperative system should strengthen the supervision on non-medicine charge in short period and reconstitute supply party profit function in the long run.