浙江省新型农村合作医疗降低就医经济风险能力的评价研究

目的：评价浙江省新型农村合作医疗实施对就医经济风险的影响。方法：应用就医经济风险评价指标RR值和校正RR值，分别计算和比较秀洲区、开化县和常山县各类就医人群获得新型农村合作医疗补偿前后就医经济风险。结果：（1）秀洲区方案显现出费用段升高。降低就医经济风险能力升高的特点：开化县方案对就医经济风险的降低主要表现在3001-5000元费用段和10000元以上费用段：常山县方案对就医经济风险的降低主要表现在10000元以上费用段。3个地区新型农村合作医疗方案均以不同形式体现了大痛统筹的指导思想。（2）由于3个地区方案侧重住院费用补偿。降低门诊就医经济风险的能力均较低。（3）秀洲区住院人群校正RR值下降了26．0％，开化县为24，9％，常山县为21．3％，秀洲区的方案对住院人群就医经济风险的降低更为有利，开化县次之，常山县最末。（4）秀洲区贫困人群校正RR值下降了34．6％，开化县为14．5％，常山县为8.8％。秀洲区的方案对贫困人群就医经济风险的降低更为有利，开化县次之，常山县最末。（5）秀洲区高危人群校正RR值下降了20．0％，开化县为16．6％．常山县为8．8％，秀洲区的方案对高危人群就医经济风险的降低更为有利，开化县次之,常山县最末。

Ability Evaluation of New-type Cooperative Medical System to Reduce Economic Risk for Medical Service in Zhejiang Province

Objective: Evaluating the impact of the New-type Cooperative Medical System(NCMS) on economic risk for medical service(ERMS) in the experimental province. Methods: Using the evaluative index of ERMS,such as RR, adjusted RR,and calculating separately the change of ERMS after the compensation of the NCMS in three experimental counties. Result: After the compensation of RCMS,the ERMS of various groups of patients in the three counties was reduced:(1)In Xiuzhou, the more the expenditure was,the more the ERMS was reduced; In Kaihua,the ERMS was reduced mostly in the section between 3 000 and 5 000 yuan,also more than 10 000 yuan; In Changshan,the ERMS was reduced mostly in the section of more than 10 000 yuan. (2)In the three counties, they all especially focused on the inpatients,so the outpatients were less compensated. (3)The RR of the inpatients in Xiuzhou was reduced by 26.0%,the one in Kaihua was reduced by 24.9%, and the one in Changshan was reduced by 21.3%. (4)The RR of the poor in Xiuzhou was reduced by 34.6%,the one in Kaihua was reduced by 14.5%,and the one in Changshan was reduced by 8.8%.(5)The RR of the high risks in Xiuzhou was reduced by 20.0%,the one in Kaihua was reduced by16.6%, and the one in Changshan was reduced by 8.8%.These figures indicated the project in Xiuzhou lean to the inpatients,the poor and the high risks more than other counties.