我国中部地区新型农村合作医疗保险运行效果评价
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摘要
目的调查了解中部地区新农合基金运行情况,评价其新农合的政策效果,同时为我国医疗保险政策完善提供参考。方法 2017年5月,抽取中部地区6个省的61个县,调查数据来源于样本县的新农合管理系统导出数据,数据整理后采用SPSS统计描述分析。结果中部地区新农合参合率与参合人数在新农合前期呈上升趋势,后期保持稳定;住院人次分布以乡镇医疗机构为主,基金流向主要以县外和县本级医疗机构为主,其中流向县外基金比例在2011—2014年超过40%;次均住院费用年均增长率9.15%,县外住院费用最高、增速最快;住院实际报销比整体呈有波动的上升趋势,2012年后实际报销比达到55%左右,不同年份基金当年结余率浮动较大,部分地区新农合后期当年基金结余率为负,累计结余率整体水平较高。结论新农合参合率较高,受到农民的认可,一定程度缓解农民的就医负担,但存在筹资机制不健全、控费机制缺乏、基金流向监管、基金运行安全问题。
Objective To examine the fund operation of the New Rural Cooperative Medical Scheme(NRCMS) in central region of China and evaluate the policy effect of the NRCMS and to provide references for the improvement of medical insurance policy in China. Methods We selected 61 counties in six provinces of Central China for the study during May 2017 and extracted relevant data of the counties from NRCMS Management System. SPSS statistical software was used to analyze the data. Results For the counties surveyed, the participation rate and the number of participants of NRCMS increased in the pre-policy period till 2009 and remained stable thereafter. The inpatient medical services of the NRCMS were mainly supported by medical institutions at township level and the flow of NRCMS fund was mainly to medical institutions at county level and those above the county level, with a fund outflow of more than 40% of the NRCMS fund to medical institutions outside the surveyed counties during the period between 2011 and 2014. The average annual growth rate for average expense of per hospitalization was 9.15%; the average expense of per hospitalization and its annual growth rate were the highest for inpatients medical service supported by medical institutions outside the counties surveyed. The actual reimbursement ratio of hospitalization showed an upward trend of fluctuation in general, with an actual reimbursement ratio of about 55% after 2012. The annual balance of the NRCMS fund fluctuated greatly among years, with negative fund balance rates in some of the counties in the latter period of NCMS and the fund accumulated balance rate of the NRCMS fund was high. Conclusion The participation rate of NRCMS is high and the operation of NRCMS alleviates the burden of medication among peasants in central regions of China. However, there are still some problems such as imperfect funding mechanism, lack of mechanism for medical expenses control, fund flow regulation and the fund operational safety for NRCMS fund operation in the regions.
Objective To examine the fund operation of the New Rural Cooperative Medical Scheme(NRCMS) in central region of China and evaluate the policy effect of the NRCMS and to provide references for the improvement of medical insurance policy in China. Methods We selected 61 counties in six provinces of Central China for the study during May 2017 and extracted relevant data of the counties from NRCMS Management System. SPSS statistical software was used to analyze the data. Results For the counties surveyed, the participation rate and the number of participants of NRCMS increased in the pre-policy period till 2009 and remained stable thereafter. The inpatient medical services of the NRCMS were mainly supported by medical institutions at township level and the flow of NRCMS fund was mainly to medical institutions at county level and those above the county level, with a fund outflow of more than 40% of the NRCMS fund to medical institutions outside the surveyed counties during the period between 2011 and 2014. The average annual growth rate for average expense of per hospitalization was 9.15%; the average expense of per hospitalization and its annual growth rate were the highest for inpatients medical service supported by medical institutions outside the counties surveyed. The actual reimbursement ratio of hospitalization showed an upward trend of fluctuation in general, with an actual reimbursement ratio of about 55% after 2012. The annual balance of the NRCMS fund fluctuated greatly among years, with negative fund balance rates in some of the counties in the latter period of NCMS and the fund accumulated balance rate of the NRCMS fund was high. Conclusion The participation rate of NRCMS is high and the operation of NRCMS alleviates the burden of medication among peasants in central regions of China. However, there are still some problems such as imperfect funding mechanism, lack of mechanism for medical expenses control, fund flow regulation and the fund operational safety for NRCMS fund operation in the regions.
引文
[1]代涛,朱坤,张小娟.我国新型农村合作医疗制度运行效果分析[J].中国卫生政策研究,2013,6(6):1-8.
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[4]国务院.国务院关于整合城乡居民基本医疗保险制度的意见[EB/OL].[2016-1-12]. http://www.gov.cn/zhengce/content/2016-01/12/content_10582.htm.
[5]杜进林,李颖琰,王禄生,等.新型农村合作医疗综合评价指标体系研究[J].中国公共卫生,2006,22(3):257-259.
[6]谷传军.我国新型农村合作医疗制度研究[D].成都:西南财经大学. 2007.
[7]赵宝,冷明祥.常熟市居民城乡一体化基本医保运行情况分析与评价[J].南京医科大学学报,2012,10(5):334-338.
[8]张小娟,田淼森,朱坤.新农合制度运行现状分析——基于6省14县的调査[J].中国卫生政策研究,2016,9(2):11-16.
[9]高丽敏.我国新型农村合作医疗可持续发展三大经济障碍分析[J].中国卫生经济,2012, 31(8):56-58.
[10]陈昭君,徐凌忠,陈立谨,等.山东省老年医保患者住院费用及影响因素路径分析[J].中国公共卫生,2016(2):152-155.
[11]国务院办公厅.国务院关于印发医药卫生体制改革近期重点实施方案(2009—2011年)的通知[EB/OL].[2009-03-18]. http://www.gov.cn/zwgk/2009-04/07/content_1279256.htm.
[12]潘庆霞,吴群红等.医保制度运行的关键节点问题综合评价研究[J].中国卫生经济,2017,36(7):28-30.
[13]卫生部农卫处.卫生部关于规范新型农村合作医疗二次补偿的指导意见[EB/OL].[2008-12-23]. http://www.nhfpc.gov.cn/jws/s6476/200812/9c67aae83b904acb82a2f355e2c54df9.shtml.
[14]殷潇,姚业楠,崔丹,等.湖北省县域医疗保险基金运行情况分析[J].中国卫生经济,2016, 35(9):47-49.
[2]王晓蕊,王红漫.基本医疗保障制度对于改善灾难性卫生支出效果评价[J].中国公共卫生,2017,33(6):901-904.
[3]国家卫生计生委.《中国新型农村合作医疗发展报告(2002-2012年)》正式出版[EB/OL].[2013-09-06]. http://www.moh.gov.cn/jws/s3582g/201309/dc9ea566f6b9427eadcf1028f470317c.shtml.
[4]国务院.国务院关于整合城乡居民基本医疗保险制度的意见[EB/OL].[2016-1-12]. http://www.gov.cn/zhengce/content/2016-01/12/content_10582.htm.
[5]杜进林,李颖琰,王禄生,等.新型农村合作医疗综合评价指标体系研究[J].中国公共卫生,2006,22(3):257-259.
[6]谷传军.我国新型农村合作医疗制度研究[D].成都:西南财经大学. 2007.
[7]赵宝,冷明祥.常熟市居民城乡一体化基本医保运行情况分析与评价[J].南京医科大学学报,2012,10(5):334-338.
[8]张小娟,田淼森,朱坤.新农合制度运行现状分析——基于6省14县的调査[J].中国卫生政策研究,2016,9(2):11-16.
[9]高丽敏.我国新型农村合作医疗可持续发展三大经济障碍分析[J].中国卫生经济,2012, 31(8):56-58.
[10]陈昭君,徐凌忠,陈立谨,等.山东省老年医保患者住院费用及影响因素路径分析[J].中国公共卫生,2016(2):152-155.
[11]国务院办公厅.国务院关于印发医药卫生体制改革近期重点实施方案(2009—2011年)的通知[EB/OL].[2009-03-18]. http://www.gov.cn/zwgk/2009-04/07/content_1279256.htm.
[12]潘庆霞,吴群红等.医保制度运行的关键节点问题综合评价研究[J].中国卫生经济,2017,36(7):28-30.
[13]卫生部农卫处.卫生部关于规范新型农村合作医疗二次补偿的指导意见[EB/OL].[2008-12-23]. http://www.nhfpc.gov.cn/jws/s6476/200812/9c67aae83b904acb82a2f355e2c54df9.shtml.
[14]殷潇,姚业楠,崔丹,等.湖北省县域医疗保险基金运行情况分析[J].中国卫生经济,2016, 35(9):47-49.