论文部分内容阅读
目的:评价新型农村合作医疗新农合参合农民乡镇住院“限费医疗”政策对住院利用、就诊流向、患者经济负担及农合资金分配的影响,为完善相关政策提供依据。方法:数据主要来源于新农合报表、医院统计报表和住院病历等资料,评价指标主要选取住院人次、次均住院费用以及次均自付费用、农合资金分配比等。分析方法主要采用描述性分析和倍差法模型,并结合访谈资料对定量研究结果进行补充和解释。结果:该政策可能增加乡镇卫生院的住院人次数,对促进患者留在乡镇卫生院的作用有限;乡镇卫生院全病种次均住院费用和自付费用均下降;实施了限费医疗政策的万宁市高血压、肺炎的次均住院费用均无明显变化,而次均自付费用分别上升了11%和28%;对新型农村合作医疗资金分配无显著影响。结论:该政策对控制医疗总费用有积极作用,但对患者合理分流和农合资金分配作用有限。对病人住院经济负担的影响因病种而异,小病可能会增加自付费用。
Objective: To evaluate the impact of the new rural cooperative medical system of rural cooperative medical care on the hospitalization, limited medical policy, the flow of hospitalization, the flow of medical treatment, the economic burden of patients and the distribution of rural cooperative medical fund, so as to provide the basis for perfecting related policies. Methods: The data mainly come from the NCMS reports, hospital statistical reports and in-patient records. The main indexes of evaluation are the number of in-hospital visits, the average hospitalization expenses, the average cost of out-of-hospital expenses, and the distribution ratio of NRCMS. The analysis method mainly uses the descriptive analysis and the multiple difference method model, and complements and explains the quantitative research results by combining the interview data. Results: This policy may increase the number of inpatients in township health centers, and has a limited effect on promoting the patients to stay in township hospitals; the average cost of hospitalization and out-of-pocket expenses for all kinds of diseases in township hospitals decrease; and the implementation of the limited-fee medical policy There was no significant change in the average cost of hospitalization for hypertension and pneumonia in Wanning City, while the average cost of secondary medical expenses increased by 11% and 28% respectively. No significant effect was found on the distribution of funds for new-type rural cooperative medical care. Conclusion: This policy has a positive effect on controlling the total cost of medical care, but it has a limited effect on the rational diversion of patients and the distribution of NRCMS. The impact on the economic burden of patients on hospitalization varies from illness to illness and may increase the out-of-pocket cost of illness.