新农合大病医保对乳腺癌患者住院费用影响的调查分析

目的 了解河南省新农合大病医保政策试点工作一年来实施效果.方法 利用河南省某三甲肿瘤专科医院200例乳腺癌患者住院费等数据进行分析.结果 新农合大病医保政策实施后,患者次均实际补偿费用增加、住院天数减少、检查费减少及治疗费增加,其变化差异有统计学意义;而住院费用、次均可报销费用及药品费在该政策实施后变化差异无统计学意义.结论 该政策的实施对遏制住院费用的增长有一定作用,对解决农村居民“看病难,看病贵”问题起到了积极作用.应加强对定点医疗机构的监督管理,合理制定限额支付金额,将次均费用及其增长幅度、平均住院日、目录内药品使用比例等指标纳入大病医保费用控制范围,还应充分发挥商业医疗保险机构作用.

Investigation of the Effect of the Serious Disease Medical Insurance of New Rural Cooperative Medical Scheme on Hospitalization Costs of Patients with Mammary Cancer

Objectives To understand the implementation effect of the Serious Disease Medical Insurance （SDMI） of New Rural Cooperative Medical Scheme （NRCMS） after one year＇s pilot work. Methods The data of hospitalization costs of 200 Mammary Cancer inpatients from a Tumor Specialized Hospital of Henan Province were analyzed.Results Comparing to the data before the implementation of the SDMI of NRCMS, the average real compensation of SDMI to the inpatient per time and the medical cost were increased, the inpatient days and the examination cost were decreased, while the inpatient cost, the average reimbursement per time and the drug cost were not changed significantly. Conclusions The SD- MI of NRCMS has effect on controlling the increase of inpatient cost in a degree, thus it plays an active role in solving the prob- lems of ＂It is expensive and difficult to see the doctor＂. Recommendation The supervision of the designated medical institution should be enhanced, the rational quota of payment should be limited, the inpatient cost per time and its increasing range, average inpatient days, the rate of the drug of the Essential Drug List. etc. , should be included in the cost control of the SDMI of NRCMS.