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目的 比较分析新农合制度下农村居民住院流向和医疗费用负担变化情况。方法 抽取黑龙江4个县49个乡镇卫生院2008—2012年新农合数据，对关键知情者进行访谈。结果 2008—2012年5年间，新农合患者住院流向发生了明显的变化，在乡镇住院比例下降了20.89个百分点，而在县及县以上机构住院人次比分别上升了10.77和10.12个百分点。4年间次均住院费增加了105%，年平均增长19.59%，其中以县以上住院增长为最高，高达78.36%。新农合的次均补偿费用增加了178%，实际补偿比从38%增长到51.85%，2012年，乡级实际补偿比达到82.82%，县级62.65%，而县外医疗机构为 37.56%。居民的个人自付比例也下降了22个百分点。结论 虽然新农合制度制定了不同机构差异化补偿政策，但单纯依赖新农合制度这一措施本身的力量，尚难以制约和改变新农合患者就医格局的逆向流动。患者越来越多地选择到县及以上大医院住院治疗的增长态势牵动了医疗费用的快速增长。如不及时出台相应政策将会给新农合资金的可持续性以及其对居民就医的经济保护能力提出严峻的挑战，亟待出台更加积极有效的措施来应对这一挑战。 |
| 关键词: 病人流向 住院医疗费用 可负担性 新型农村合作医疗 |
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| Analysis of the Change Tendency of Inpatient Flow and Hospital Cost Burden Among Rural Residents Under New Rural Cooperative Medical Scheme |
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| Abstract: |
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Objective
To comparatively analyze the inpatient flow and hospital cost burden among rural residents under new rural cooperative medical scheme. Methods Selecting 4 counties and 49 township hospitals NCMS data from 2008 to 2012 in Heilongjiang Province, and the key informants were interviewed. Results From 2008 to 2012, the flow of inpatients with NCMS have significantly changed. The number of people hospitalized in township hospital declined by 20.89 percent, while the portion of people hospitalized in the county and people hospitalized outside the county increased by 10.77 percent and 10.12 percent. During the 4 years, average hospitalization costs increased by 105% with average annual growth rate at 19.59%, and among them county-level hospitals increased at the highest rate with 78.36%. At the same time, average reimbursement rate also increased by 178%, and the actual reimbursement rate grew from 38% to 51.85%. In 2012, the actual reimbursement rate at township level hospital reached to 82.82%, county-level hospitals reached 62.65%, while at hospitals above county level was only 37.56%. Individual’s copayment rate decreased 22 percent. Conclusion Although the NCMS develops a different compensation policy between different agencies, but relying solely on this measure itself is still difficult to control and alter the pattern of inpatients flow. More and more NCMS patients choose to be treated in the county hospitals or large hospitals above resulted in the rapid growth of medical costs. If not handled timely, this problem will threaten the sustainability of NCMS funds and its financial ability to protect inpatients. It is urgently needed to take more effective and systematic measures to deal with this challenge. |
| Key words: inpatient flow,hospital cost,affordability,New Rural Cooperative Medical Scheme |
