北京市新型农村合作医疗制度住院报销模式研究

目的总结北京市现行的新型农村合作医疗(新农合)住院报销政策,分析其中存在的问题,并提出相应的建议。方法对北京市各级新农合管理者进行深入访谈,了解各样本区新农合的住院报销政策,获取各区新农合住院报销的数据;问卷调查6区县1080户农民的人口学特征、就诊模式、对各级医疗机构的评价、对新农合政策的态度、理想的报销比例、支付意愿等。结果北京市2006年农民新农合参合率为89.7%,全市区县级以上医院住院补偿比例为31.46%,区县级医院为30.49%,乡镇卫生院为39.76%。有67.9%的农民认为报销比例低,理想的报销比例平均为65.7%。农民生大病首选去区县级医疗机构的最多,占55.0%。仅有8.6%的农民认为卫生院医疗设备较好,5.5%的农民认为卫生院医生技术较好。结论北京市新农合乡参合率较高,但镇卫生院利用率低,大医院医疗费用过高,新农合资金面临透支风险。建议在筹资水平不断提高的情况下将新农合提高到市级统筹,调整各级医院的住院报销比例,适当扩大报销范围。

Inpatient Reimbursement Mode of New-type Cooperative Medical System in Beijing

Objective To summarize the inpatient reimbursement policies of new-type cooperative medical system in 6 districts in Beijing;to analyze the problems of the policies and give some advices.Methods Governors of NCMS and 1 080 families were interviewed in 6 districts.Results In Beijing in 2006 the proportion of rural people who take part in the new-type cooperative medical system was 89.7% and the inpatient reimbursement ratio in city-level hospitals was 31.46%,in county-level hospitals was 30.49%,and in township health center was 39.76%.67.9% of the investigated people thought that the inpatient reimbursement ratio was lower than they wished,which was 65.7%.55.0% of the investigated people will go to county-level hospitals when they have serious diseases.8.6% of them thought the township health center facilities were good and 5.5% of them thought the technology of the doctors was good.Conclusion We suggest that the government should finance NCMS at the city level rather than district level;adjust the inpatient reimbursement ratio and simplify the way of how to apply for reimbursement;make policies for affluent rural residents.