湖北省某县新型农村合作医疗住院服务过度需求病种分析

目的：明确新农合病人住院服务过度需求的机构及病种分布特征,为不合理入院的监管提供依据。方法：通过“明确的非诊断性标准法”对湖北省某县2乡镇883份非分娩住院病人在三级医疗机构（县级以上、县级及乡镇卫生院）住院病历进行评估,找出不合理入院病种及特征。结果：新农合不合理人院病人主要集中在县乡两级医疗机构,在县乡两级医疗机构不合理人院的病种构成无显著性差异,但支气管（肺）炎和泌尿系统感染在乡县两级医疗机构的不合理入院发生率有差异。结论：新农合对不合理入院有驱动作用,不合理入院的监管应该考虑从病种及医疗机构级别制定策略。

Analysis of Disease of the Excessive Demand Patients Covered by the New Rural Cooperative Medical System in a County, Hubei

Objective：To make clear the flow and the diseases distribution characteristics of the excessive demand patients covered by the New Rural Cooperative Medical System （NRCMS）, and provide the basis for regulation unreasonable admitted in Chinese rural area. Methods： 883 medical records of patients from 2 different towns in one county were evaluated by ＂explicit Non diagnostic criteria＂. Results： we found that patients who had no need to get inpatient service were admitted by township health service institutions and county hospitals. And at different level of medical institutions, disease of unreasonable admission have no marked difference, but unreasonable admission rate of bronchopneumonia and u rinary infection in the two level of medical institutions has significant difference. Conclusion：We analyses that how the NRCMS drives the supplier and the demander to supply or get the excess in patient service in Chinese rural area, and proposes the regulatory strategy of unreasonable admis sion should be carried out aecordin to the characters of disease and medical institutions.