基于发展模型的新型农村合作医疗支付方式改革控费效果分析

The Analysis on effectiveness of Controlling the Costs under the New Rural Cooperative Medical Care Payment Reform Based on the Development Model

目的:利用发展模型评价江夏区新型农村合作医疗按例均费用定额付费支付方式改革控费效果。方法:利用新型农村合作医疗管理系统收集新型农村合作医疗基金运行数据,分别应用随机截距模型、随机截距/斜率模型对数据进行拟合,加入改革变量进行模型优化。结果:拟合数据组间异质性显著(σ2μ0=1.134 6,P=0.000 3);例均医疗费用随时间变化率的差异存在统计学差异(σ2μ1=0.037 33,P=0.000 5);变量"改革"与"时间"交互作用并不显著(σμ01=-0.051 4,P=0.075 5)。结论:按例均费用定额付费支付方式改革可以控制费用过快增长,采用纳入改革变量的模型拟合效果最优。

Objective:Using development model to evaluate the effectiveness of controlling the costs under the service unit pay-ment reform of new rural cooperative medical system(NCMS) in Jiangxia District.Methods:The NCMS fund data was collected fromthe NCMS management system. Intercept heteroscedasticity model and slope model were randomly applied to fit the data respectively,and the reform variable was to optimize the model.Results:The heterogeneity among the fitting data groups were significant(σ2μ0=1.1346,P=0.0003). There was statistically significant difference over rate of time change in the average medical expense(σ2μ1=0.03733,P<0.0005). There was no statistically significant difference over interactive effect between'Time'and'Reform'(σμ01=-0.0514,P=0.0755).Conclusion:The payment reform of service unit payment could control the over-increased growth of thecosts. It was good to apply the reform variable of model simulating effectiveness.