| 摘要: |
| 目的 分析农村儿童先天性心脏病医疗保障试点工作运行效果。方法 运用SPSS17.0软件对湖北省A县先天性心脏病住院患儿就医费用及补偿数据进行分析。结果 先天性心脏病患儿实际补偿比低于新农合全体患者，患者负担沉重；支付方式改革有效控制了费用增长，定额支付标准能够引导供方诊疗行为；支付方式改革可能出现了人为加重诊断的负面效应。结论 逐步扩大重大疾病保障的病种覆盖范围，采用混合式的补偿模式，科学疾病分类、制定和调整单病种定额支付标准，针对支付方式改革可能产生的负面效应针对性地加强医疗机构监管。 |
| 关键词: 儿童 先天性心脏病 医疗保障 |
| DOI： |
|
| 基金项目: |
|
| Analysis of Medical Security of Rural Children with Congenital Heart Disease in A County, Hubei Province |
|
| () |
| Abstract: |
|
Objective
To analyze operating conditions of medical security pilot work of rural children. Method Using SPSS 17.0 software to analyze their inpatient expenses and reimbursement data. Result Their actual inpatient reimbursement rate of NRCMS is still lower than that of all inpatients in NRCMS，and their economic burden is still heavy；the reform of payment method has controlled the rising of inpatient expenses effectively，and the standard of DRGs can guide medical institutions’ behavior；the reform of payment method may result in some negative effect that rising the severity of the disease diagnosis artificially. Conclusion The coverage scope of major and severe diseases medical security should be expended； mixed model of medical security be used； diseases be clarified, expense standard of DRGs be set and adjusted scientifically；and supervision towards medical institutions be reinforced. |
| Key words: children,congenital heart disease,medical security |
