安溪县新型农村合作医疗3年运行绩效研究

目的]评价安溪县新型农村合作医疗(新农合)运行3年的绩效,探讨高额住院费用的主要影响因素。方法]收集该县3年来住院补偿数据,以SPSS软件包评价主要补偿指标,分析影响因素,并对3年的运行绩效综合评价。结果]3年来新农合运行基本平稳,第3年度参合率已近90%,基金使用率85.0%,平均住院费仅3 621元,次均补偿额1 210元,病人流向的81.2%、费用流向的61.2%在县内;实际补偿比达39.2%;药占比47.2%;范围外占比25.5%;网络管理后县内出院病例可立即兑现报销。产生高额住院费用的影响因素是:出县住院(OR=24.6)、住院久、患癌症和范围外费用占比高。存在的主要问题是出县住院者与范围外费用占比呈上升趋势。结论]3年来该县新农合运行良好且较平稳,深受农民欢迎。建议今后加强医疗机构监管,减少范围外费用;将住院分娩费用纳入正常补偿范围;加强投入以改善县内医疗条件。

Study on Performance of New Cooperative Medical System in An'xi,Fujian

Objective]To evaluate the performance of new cooperative medical system (NCMS) for 3 years in An'xi, Fujian,and explore the main influence factors of"high hospitalization fare".Methods]The remedy data were collected and analyzed by SPSS package for synthetically evaluating the performance,and analyzing the influence factors.Results] The performance indicators were basically good and stable.The percentage of joining NCMS was closed to 90%,fund ex- penditure reached to 85.0%,mean hospitalization fare was 3 621 Yuan,the remedy fare was 1 210 Yuan.The hospitaliza- tion cases (81.2%) and fares (61.2%) were in the county.The actual remedy ratio reached to 39.2%.The ratio of drug fare was 47.2%.The ratio of non-remedy fare was 25.5%.The day interval from leaving hospital to remedy was at once recently by using internet.The influence factors of"high hospitalization fare"were out of the county for hospitalization (OR=24.6),longer staying at hospital,suffering cancers and higher ratio of non-remedy fare.The existed problems were:the percentage of"hospitalization at higher hospital levels"and the ratio of non-remedy fare were at increasing trend.Conclusion]The NCMS performance in An'xi is basically good and stable and welcome by farmers.The key measures should be carried out in the future were:strengthening hospital inspection and management,reducing the ratio of non-remedy fare,childbirth cases should be listed as normal remedy policy,and increasing governmental subsidy for im- proving medical services.