| 引用本文: |
荆丽梅,舒之群,李明,等.新型农村合作医疗按人头支付政策干预的实证效果评价[J].中国卫生经济,2017,(7):35-37.[点击复制] |
.The Empirical Evaluation of Capitation Payment Policy Intervention in New Rural Cooperative Medical System (NCMS)[J].CHINESE HEALTH ECONOMICS,2017,(7):35-37.[点击复制] |
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| 摘要: |
| 目的：对新型农村合作医疗按人头支付政策干预的实证效果进行评价。方法：收集2011-2015年浦东新区按人头支付干预前后新型农村合作医疗相关数据指标，评价政策干预对基金运行、就诊行为和补偿状况等的总体影响。结果：基金筹资水平不断提高，2015年人均筹资标准已达到2000元/人；基金运行风险得到控制，2015年当年基金结余率达到8.84%；参合对象医疗服务需求逐年释放，2015年参合对象的年人均门诊就诊次数达到20次，年住院率为10%；医疗费用迅速增长的态势得到遏制，尤其次均住院费用增幅下降明显； 2015 年参合对象门诊和住院医疗费用的实际补偿比分别为60%和55%。结论：按人头支付政策实施3年多来，在费用控制方面取得了较好的效果。但在城乡基本医疗保险一体化管理的背景下，参合对象医疗费用的实际补偿比有待进一步提高。 |
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| The Empirical Evaluation of Capitation Payment Policy Intervention in New Rural Cooperative Medical System (NCMS) |
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| Abstract: |
| Object: To empirically evaluat e the effect of capitation payment policy intervention in new rural cooperative medical system (NCMS). Methods: Evaluate the overall impact of policy intervention on the fund operation, compensation, and medical-care-seeking behavior by collecting relative data on capitation payment policy intervention in NCMS in pudong new area from the year of 2011 to 2015, which duration i ncludes data before and after the reform . Results: The financing level was improved unceasingly, in 2015 the per capita financing standard has reached RMB 2000 yuan; the operation risk was under control, the balance rate was 8.84%; the medical service demand of insured was released year by year, in 2015 the per capita service was up to 20 times per year , and yearly hospitalization rate was 10%; the trend of rapid growth of medical expense was c ontained, especially the growth of average hospitalization expenses dropped significantly; in the year of 2015, the actual subsidy proportion of medical expenses for insured outpatient and inpatient were 60% and 55% respectively. Conclusion: After over 3 years’ c apitation payment reform in NCMS, good results have been achieved in terms of cost control. However, under the background of the integration of urban and rural basic medical insurance , the actual subsidy proportion of medical expenses for insured remains to be further improved. |
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