甘肃省新农合运行情况分析

Analyzing the Status of Operation of New Rural Cooperative Medical System in Gansu Province

目的:调查了解甘肃省新农合基金运行情况,评价甘肃省新农合的实施效果,同时为甘肃省医疗保险政策提供参考。方法:分层抽样法抽取甘肃省25个县,调查数据来源于样本县的新农合填报数据,数据整理后采用SPSS统计描述分析。结果:甘肃省新农合参合率与参合人数在政策前期呈上升趋势,后期保持稳定;住院人次分布在新农合政策前期以乡镇医疗机构为主,后期以县本级医疗机构为主,基金流向在新农合政策前期以县本级医疗机构为主,后期以县外医疗机构为主;次均住院费用年均增长率9. 58%,其中县外住院费用最高、增速最快,住院实际报销比整体呈有波动的上升趋势,政策后期达到60%左右,自付住院费用调整值整体呈下降趋势,从新农合政策初期的70%左右下降到后期的30%;政策前期基金结余率较高,后期结余率水平较低,有较多县市当年基金结余率为负。结论:甘肃省新农合参合率较高,受到农民的认可,一定程度缓解了农民的就医负担,但在控费机制、基金流向监管及基金运行安全问题等方面有待进一步加强与完善。

Objective To investigate the operation of the New Rural Cooperative Medical System （NRCMS） fund in Gansu Province, and provide references for medical insurance policy in Gansu Province. Method 25 counties were chosen with stratified sampling method in Gansu Province. Data from NRCMS report was analyzed by statistical description.＇ Results The participation rate and number of insured person in NRCMS in Gansu Province increased at the early stage, and remained stable in the later period. Inpatients were mainly distributed in township medical institutions in the early stage, and mainly in county medical institutions in the later. The fund was mainly transferred to county medical institutions in the early stage, and transferred to medical institutions outside the county in the later. The average annual increase rate of hospitalization costs was 9. 58%, of which the cost of hospitalization outside the county was the highest, with the highest speed of growth. The actual reimbursement of hospitalization had a fluctuating upward trend. And the adjustment value of self - payment of hospitalization costs declined as a whole from about 70% in the initial period to 30% in the later period. In the early period of the policy, the surplus rate of the fund was higher. While it declined in the later period, which was negative in many counties and cities. Conclusion The participation rate of NRCMS in Gansu Province was relatively high, which was recognized by rural residents. It can alleviate their medical burden, but needs to be further improved in fee control mechanism, supervision of fund flow and the security of fund operation.