湖南省新型农村合作医疗筹资与补偿方案研究
|
摘要
目的通过对湖南省新型农村合作医疗(新农合)制度现有运行情况进行全面调查,掌握相关资料,深入分析湖南省新型农村合作医疗现状、存在问题、居民健康状况、住院费用及相关影响因素,探讨解决新型农村合作医疗工作中存在问题的方法,建立合理的筹资与补偿方案,为合理配置湖南省卫生资源,促进新型农村合作医疗健康发展提供依据。
方法采用多级整群随机抽样方法,从湖南省11个新农合试点地区中的每一个地区随机抽取一个县(市、区)构成研究样本。对于抽样县参合农民住院基本情况、新农合基金补助受益情况以及补偿方案的设计等采用数据分析方法。具体如下：(1)对样本人群的人口学特征、住院基本情况等采用描述性分析,两组或多组计数资料的比较采用卡方检验；(2)应用单因素及有序多分类的logistic回归模型分析参合农民住院费用及其影响因素；(3)2006年湖南省抽样县新农合基金运行情况,如筹资、基金使用、补助收益、基金流向等方面采用描述性分析方法；(4)基于上述研究并结合目前新农合政策,设计合理的费用补偿方案,建立费用补偿测算模型,并进行实证研究。
结果2006年湖南省建立新型农村合作医疗制度的县(市、区)共有43个,覆盖农村人口2463.5万人；参加新农合的农民达1857.2万人,平均参合率为75.39%。抽取11个样本县(市),合计参合人数694376人,其中男性365014人,占总人数的52.57%,女性329362人,占47.43%。
(1)住院服务情况分析：在定点医疗机构的平均住院率为7.02%,其中桑植、双牌、会同、石门、岳阳的住院率较高,分别为11.93%、10.57%、8.80%、8.26%、7.23%。参合农民中女性的住院率高于男性,分别为8.01%和6.13%；不同年龄的参合农民住院率呈“V”字型分布,15-岁组的住院率最低为4.29%,60岁以上组住院率最高为12.26%；疾病别住院率前五位的疾病为呼吸系统疾病(22.91%)、消化系统疾病(16.77%)、泌尿生殖系统疾病(10.20%)、中毒及损伤(9.60%)、循环系统疾病(8.44%)；住院病人的流向分析结果显示60.67%的参合农民在乡镇级别的医疗机构住院。(2)新农合住院费用分析：住院费用的单因素和有序多分类的logistic回归分析显示,性别、年龄、住院天数、医疗机构的级别、地区经济水平、病种六个变量对住院费用均有影响。其中男性的次均住院费用高于女性；次均住院费用随着年龄的增加而增加：小于15岁组的次均住院费用最低为1038.12元,60岁以上组次均住院费用最高为2017.17元；住院天数的长短与住院费用成正相关,住院天数越长,次均住院费用越高；医疗机构级别越高次均住院费用越高：省级定点医疗机构次均住院费用最高为9070.67元,乡镇医疗机构的次均住院费用最低为781.52元；住院费用与地区经济发展水平相关,经济发展水平高的地区次均住院费用最高2311.20元,欠发达地区次均住院费用最低1249.16元；有序多分类的logistic回归分析结果显示：肿瘤的次均住院费用最高,先天异常,筛检、术后放化疗和康复,神经与行为障碍,围生期疾病等的次均住院费用次之,呼吸系统疾病,耳和乳突疾病,皮肤和皮下组织疾病次均住院费用最低。
(3)2006年湖南省抽样县市新农合基金运行情况：筹集基金总额3308.60万元,其中参合农民个人缴费694.38万元,占基金总额的20.99%,各级财政补助资金2614.23万元,占基金总额的79.01%。用于住院补助的基金总额为2510.95万元,占筹集基金总额的75.89%。共补助住院48500人次,受益面为6.98%,其中桑植、双牌、会同、石门、岳阳5个县的受益面高于全省平均水平,桑植和双牌的受益面最高,分别为11.87%和10.52%；而望城、花垣、炎陵、湘乡、桂阳和常宁6个县市低于全省平均水平,最低的是常宁,其受益面仅为3.19%。参合农民住院实际花费8344.22万元,补助资金为2510.95万元；次均住院费用为1711.25元,次均可报费用为1492.61元,次均补助费用为514.95元,全省平均受益度为30.09%。其中桑植、石门、常宁、花垣、会同5县市的受益度高于全省平均水平,另外6个县市则低于全省平均水平。受益度最高的和受益度最低的县市分别是花垣(38.68%)和湘乡(22.16%)。2006年全省住院补助人次主要集中在乡级和县级,县乡两级机构占补助人次数的86.99%。与此相对应,住院补助资金流向县级和乡级的比例亦较大,但不成比例。乡级医疗机构住院补助人次占总补助人次的60.63%,但资金流向比例只为39.32%；县级医疗机构住院补助人次占总补助人次的26.36%,但资金流向比例达35.13%。各县市补助人次和补助资金流向存在一定差异,部分县市住院人次流向省级和市级的比例较大。
(4)费用补偿方案的设计：基于“起付线+共同保险+封顶线”的混合支付体制,根据合作医疗基金分配测算的基本原理,即“以收定支、收支平衡”,重点考虑参合率、住院统筹基金总量、住院率、各级次均住院费用、病员流向结构及疾病对家庭和对社会的危害等因素,设计了四套补偿方案。一级、二级和三级医疗机构的起付线分别是100元、300元和500元,封顶线均为6万元。不同级别医疗机构不同病种设定不同的补偿比例。通过实证研究和评价,结果显示方案2的效果最好,住院实际补偿率达到49.68%,补偿资金达到住院统筹基金的99.44%。方案2的具体情况是：肿瘤、传染病、住院分娩、次均住院费用高(≥1000元)的病种、次均住院费用低(<1000元)的病种在一级医疗机构的补偿比率分别为85%、80%、55%、75%、70%,在二级医疗机构分别为80%、75%、65%、70%、65%,在三级医疗机构分别为70%、65%、70%、60%、55%。
(5)建立了方便实用的补偿费用测算模型
结论
(1)参合农民的住院服务利用水平较高,育龄期妇女、15岁以下和60岁以上的参合农民是住院卫生服务的重点人群；参合农民住院原因以感染性疾病为主(呼吸系统、消化系统、泌尿系统),但同时慢性非传染病(循环系统疾病)的患病率明显增加。
(2)性别、年龄、住院天数、医疗机构的级别、地区经济水平和病种是住院费用的影响因素。
(3)湖南省新型农村合作医疗自2003年试点以来参合率逐年提高,但参合积极性还有待进一步提高。筹资水平偏低,基金使用率稍低于政策规定要求,部分县市基金沉淀过多。受益面窄,多数参合农民不能受益；补偿率偏低,农民受益度不高；补助水平不平衡,多数县市合作医疗减轻农民医疗负担的作用和效益还没有充分发挥出来。但补助人次流向和补助资金分布总体上比较合理,主要集中在乡、县级医疗机构。
(4)针对新农合运行现状,因地制宜的探讨科学合理的费用补偿方案,制定合理的起付线、封顶线和不同级别医疗机构、不同病种的补偿比例,能充分发挥合作医疗基金的补偿效益,又能促使医疗卫生资源的合理利用和分配。通过费用补助减轻农民因病就医的费用负担至关重要。
(5)本研究建立的补偿费用测算模型是方便和实用的。实证研究证实,在现有的筹资水平下,本研究提出的补偿方案2是目前最科学和合理的方案,能有效发挥合作医疗基金的保障作用。
Objectives
An investigation on the operation of the New Rural Cooperative Medical System (NRCMS) in Hunan was made to obtain relevant data and further analyze the status including existing problems of NRCMS in Hunan, rural residents'health status, hospitalization expenses and the influencing factors in order to explore the possible solutions for the problems in NRCMS and provide the basis for reasonable allocation of the health resources in Hunan to promote the sustainable development of NRCMS.
Methods
With multistage clusters random sampling, one county (city and district) from each of 11 prefectures in Hunan where NRCMS pilot programs were implemented was randomly selected to build the study sample. Data analysis was used for the study of NRCMS participants' hospitalization, reimbursements by the NRCMS fund and design of the reimbursement scheme. Detailed information is as follows:1) Descriptive analysis was used for the demographical data and hospitalization of the sample and chi-square test was used for comparison of the quantitative data of two and more groups; 2) single factor and ordinal multi-category logistic regression model was used for analysis of NRCMS participants' hospitalization expenses and the influencing factors; 3) descriptive analysis was used for the operation of the NRCMS fund in the sampled counties in Hunan in 2006, including financing, fund utilization and reimbursement and fund distribution; 4) based on the above study and in combination of the NRCMS policy a reasonable expense reimbursement scheme was designed and a model of expense reimbursement calculation was established. Meanwhile an empirical study on them was made.
Results
NRCMS was implemented in forty-three counties (cities and districts) in Hunan, covering a population of about 24,635,000 rural residents, among which about 18,572,000 joined in NRCMS and the average participation rate was 75.39%. Eleven counties (cities and districts) were chosen with a total of 694,376 participants, among which 365,014 (52.57%) were men and 329,362 (47.43%) women.
1) Analysis of hospitalization service. The average hospitalization rate in the NRCMS contracted hospitals was 7.02%; the hospitalization rates in Sangzhi, Shuangpai, Huitong, Shimen and Yueyang were high:11.93%、10.57%、.80%、.26%、7.23%, respectively; women participants'hospitalization rate was higher than men's:8.01% and 6.13%, respectively; The distribution of the hospitalization rate of the participants at different age was like the letter V:the hospitalization rate of the group of 15-29 years old was the lowest (4.29%) and of the group of aged 60 and above was highest (12.96%); the top five diseases of the hospitalization rate were respiratory system diseases (22.91%), digestive system diseases (16.77%), urinary and reproductive system diseases (10.20%), poisoning and injury (9.6%), circulation system diseases (8.44%); The analysis of the distribution of hospitalized patients showed that 67.67% of the NRCMS participants were hospitalized in township medical institutions.
2) Analysis of hospitalization expense. The analysis of hospitalization expenses through single factor and ordinal multi-categroy logistic regression analysis showed that all six variables including gender, age, days of hospitalization, level of hospitals, economic level of the counties and types of diseases influenced hospitalization expenses. The average hospitalization expense per visit for men was higher than that for women; The hospitalization expense increased as age increased:The hospitalization expense per visit for the group of the age below 15 was the lowest:1038.12 yuan while the hospitalization expense per visit for the group of above 60 years old was highest:2017.17 yuan; The duration of hospitalization was positively correlated with hospitalization expense:the longer the duration of hospitalization was, the higher the hospitalization expense per visit was; the higher the level of the hospitals were, the higher the hospitalization expense per visit were; hospitalization expense per visit in the contracted provincial hospitals was highest:9070.67 yuan, and hospitalization expense per visit in township hospitals was lowest:781.52 yuan; hospitalization expense was related with the economic development level in the county:hospitalization expense per visit in the county of the high economic development level was highest: 2311.20 yuan, the hospitalization expense per visit in the county of the low economic development level was lowest:1249.16 yuan. Ordinal multi-categroy logistic regression analysis showed that hospitalization expense per visit for tumor was highest, that for congenital anomaly, screening and postoperative radio chemotherapy and rehabilitation, neural and behavioral disorder, and perinatal diseases took the second place, that forrespiratory system diseases, ear and mastoid diseases,dermatological and subcutaneous tissue diseases was lowest.
3) Operation of NRCMS in the sampled counties (cities) in Hunan in 2006. The total of raised fund was 33,086,000 yuan, among which NRCMS participants made contribution of 6,943,800 yuan,20.9% of the total fund, and public finance at all levels paid 26,142,300 yuan as allowance,79.01% of the total fund. The total of fund used for hospitalization reimbursement was 25,109,500 yuan, which is 75.89% of the total of raised fund, and 48,500 visits were reimbursed for hospitalization expense. The beneficiary rate was 6.98%. The beneficiary rates of Sangzhi, Shuangpai, Huitong, Shimen, and Yueyang were higher than the average provincial beneficiary rate. The beneficiary rates of Sangzhi and Shuanpai were highest:11.87% and 10.52%, respectively; the beneficiary rates of Wangcheng, Huayuan, Yanling, Xiangxiang, Guiyang and Changning were lower than the average provincial beneficiary rate; the beneficiary rate of Changning was lowest:3.19%. The actual hospitalization expense that the NRCMS participants paid was 83,442,200 yuan, reimbursement was 25,109,500 yuan; hospitalization expense per visit was 1711.25 yuan, and the expense per visit that could be reimbursed was 1492.61 yuan, reimbursement for each visit was 514.95 yuan, and the average provincial reimbursement rate was 30.09%. The reimbursement rates of Sangzhi, Shimen, Changning, Huayuan, and Huitong were higher than the average provincial reimbursement rate while the reimbursement rates of the other 6 counties (cities) were lower than the average provincial reimbursement rate. The highest and the lowest reimbursement rates were that of Huayuan (38.68%) and that of Xiangxiang (22.16%), respectively. In the year 2006 hospitalization reimbursement mainly concentrated on the hospitalizations in township and county hospitals that consisted of 86.99% of the reimbursed visits. Correspondingly, the proportion of the reimbursement for hospitalization in township and county hospitals was fairly big, but disproportionate. The reimbursement for hospitalization in the township hospitals consisted of 60.63% of the total reimbursed visits, but the proportion of reimbursement distribution was 39.32%. The reimbursement for hospitalization in county hospitals consisted of 26.36% of the total reimbursed visits, but the proportion of reimbursement distribution was 35.13%. There were difference among reimbursed visits and reimbursement distribution in the counties (cities) and the proportion of some counties'hospitalizations that went to prefecture level and provincial hospitals was fairly big.
4) Design of expense reimbursement scheme. According to the basic principles of the calculation of the NRCMS fund, that is, "payout depends on income and balance of payments", and based on the payment system of "deductible coverage plus coinsurance and ceiling" major considerations was given to NRCMS participation rate, the total of hospitalization co-ordination fund, rate of hospitalization, hospitalization expense per visit in the hospitals at all levels, patient distribution, and harm done to family and society by diseases and other factors. Four reimbursement schemes were designed. The deductible coverage for the medical institutions at the first, second and third levels were 100 yuan,300 yuan, and 500 yuan, respectively and the ceiling for all was 60,000 yuan. A specific proportion of reimbursement for the expenses for specific diseases in the hospitals at different level was designed. The results of the empirical study and evaluation showed that the 2nd scheme was the best:the rate of hospitalization reimbursement was actually 49.68% and the reimbursed expense was 99.44% of the hospitalization fund. The 2nd reimbursement scheme was as follows: the rate of reimbursement for the hospitalization expense for tumor, infectious diseases, delivery, diseases with average hospitalization expense per visit of one thousand yuan or more, and diseases with average hospitalization expense per visit of less than one thousand yuan were 85%,80%,55%,75% and 70%, respectively in the hospitals at the first level; 80%,75%,65%,70%and 65%, respectively in the hospitals at the second level; 70%,65%,70%, 60% and 55%, respectively in the hospitals at the third level.
5) A convenient and practical model of expense reimbursement calculation was made:M=N×ΣPij×Eij×Rij×(1+F) (i=1,2,3,j=1,2,3,4,5).
Conclusions
The following conclusions have been drawn in the study:
1) The utilization level of hospitalization service by NRCMS participants was high, and women of childbearing age, and participants of 15 years and below, and 60 years and above were the key population of hospitalization service; the majority of the diseases for which the NRCMS participants were hospitalized were infectious diseases (of respiratory system, digestive system and urological system). But at the same time prevalence of chronic non-infectious diseases increased obviously.
2) The influencing factors for hospitalization expense included gender, age, days of hospitalization, level of hospitals, economic level, and type of disease.
3) The participation rate of NRCMS in Hunan increased annually ever since the pilot program of NRCMS started in Hunan in 2003. The enthusiasm for participation in NRCMS needs to be further promoted. The level of financing was low. The rate of use of NRCMS fund was slightly lower than that required in the policy and too much surplus was left over. The majority of the NRCMS participants did not benefit from the fund; the rate of reimbursement was low; the level of reimbursement was not balanced so that the role and effect NRCMS in many counties (cities and districts) played in reducing medical burden was not achieved. However, the reimbursed visits to hospitals and distribution of reimbursement were generally reasonable, mainly concentrated on township and county medical institutions.
4) To explore a scientific and reasonable expense reimbursement scheme according to the conditions in specific counties (cities and districts), to set up deductible coverage, ceiling and the proportion of reimbursement for hospitals at different levels and for specific type of diseases can help maximize the reimbursement effect of NRCMS and facilitate the reasonable use and allocation of health resources. It is vital that the burden of farmers'medical expense be reduced through reimbursement.
5) The model of expense reimbursement calculation made in this study was convenient and practical. It was proved in the empirical study that the 2nd reimbursement scheme established in the study was most scientific and reasonable so far for the present level of NRCMS financing.
方法采用多级整群随机抽样方法,从湖南省11个新农合试点地区中的每一个地区随机抽取一个县(市、区)构成研究样本。对于抽样县参合农民住院基本情况、新农合基金补助受益情况以及补偿方案的设计等采用数据分析方法。具体如下：(1)对样本人群的人口学特征、住院基本情况等采用描述性分析,两组或多组计数资料的比较采用卡方检验；(2)应用单因素及有序多分类的logistic回归模型分析参合农民住院费用及其影响因素；(3)2006年湖南省抽样县新农合基金运行情况,如筹资、基金使用、补助收益、基金流向等方面采用描述性分析方法；(4)基于上述研究并结合目前新农合政策,设计合理的费用补偿方案,建立费用补偿测算模型,并进行实证研究。
结果2006年湖南省建立新型农村合作医疗制度的县(市、区)共有43个,覆盖农村人口2463.5万人；参加新农合的农民达1857.2万人,平均参合率为75.39%。抽取11个样本县(市),合计参合人数694376人,其中男性365014人,占总人数的52.57%,女性329362人,占47.43%。
(1)住院服务情况分析：在定点医疗机构的平均住院率为7.02%,其中桑植、双牌、会同、石门、岳阳的住院率较高,分别为11.93%、10.57%、8.80%、8.26%、7.23%。参合农民中女性的住院率高于男性,分别为8.01%和6.13%；不同年龄的参合农民住院率呈“V”字型分布,15-岁组的住院率最低为4.29%,60岁以上组住院率最高为12.26%；疾病别住院率前五位的疾病为呼吸系统疾病(22.91%)、消化系统疾病(16.77%)、泌尿生殖系统疾病(10.20%)、中毒及损伤(9.60%)、循环系统疾病(8.44%)；住院病人的流向分析结果显示60.67%的参合农民在乡镇级别的医疗机构住院。(2)新农合住院费用分析：住院费用的单因素和有序多分类的logistic回归分析显示,性别、年龄、住院天数、医疗机构的级别、地区经济水平、病种六个变量对住院费用均有影响。其中男性的次均住院费用高于女性；次均住院费用随着年龄的增加而增加：小于15岁组的次均住院费用最低为1038.12元,60岁以上组次均住院费用最高为2017.17元；住院天数的长短与住院费用成正相关,住院天数越长,次均住院费用越高；医疗机构级别越高次均住院费用越高：省级定点医疗机构次均住院费用最高为9070.67元,乡镇医疗机构的次均住院费用最低为781.52元；住院费用与地区经济发展水平相关,经济发展水平高的地区次均住院费用最高2311.20元,欠发达地区次均住院费用最低1249.16元；有序多分类的logistic回归分析结果显示：肿瘤的次均住院费用最高,先天异常,筛检、术后放化疗和康复,神经与行为障碍,围生期疾病等的次均住院费用次之,呼吸系统疾病,耳和乳突疾病,皮肤和皮下组织疾病次均住院费用最低。
(3)2006年湖南省抽样县市新农合基金运行情况：筹集基金总额3308.60万元,其中参合农民个人缴费694.38万元,占基金总额的20.99%,各级财政补助资金2614.23万元,占基金总额的79.01%。用于住院补助的基金总额为2510.95万元,占筹集基金总额的75.89%。共补助住院48500人次,受益面为6.98%,其中桑植、双牌、会同、石门、岳阳5个县的受益面高于全省平均水平,桑植和双牌的受益面最高,分别为11.87%和10.52%；而望城、花垣、炎陵、湘乡、桂阳和常宁6个县市低于全省平均水平,最低的是常宁,其受益面仅为3.19%。参合农民住院实际花费8344.22万元,补助资金为2510.95万元；次均住院费用为1711.25元,次均可报费用为1492.61元,次均补助费用为514.95元,全省平均受益度为30.09%。其中桑植、石门、常宁、花垣、会同5县市的受益度高于全省平均水平,另外6个县市则低于全省平均水平。受益度最高的和受益度最低的县市分别是花垣(38.68%)和湘乡(22.16%)。2006年全省住院补助人次主要集中在乡级和县级,县乡两级机构占补助人次数的86.99%。与此相对应,住院补助资金流向县级和乡级的比例亦较大,但不成比例。乡级医疗机构住院补助人次占总补助人次的60.63%,但资金流向比例只为39.32%；县级医疗机构住院补助人次占总补助人次的26.36%,但资金流向比例达35.13%。各县市补助人次和补助资金流向存在一定差异,部分县市住院人次流向省级和市级的比例较大。
(4)费用补偿方案的设计：基于“起付线+共同保险+封顶线”的混合支付体制,根据合作医疗基金分配测算的基本原理,即“以收定支、收支平衡”,重点考虑参合率、住院统筹基金总量、住院率、各级次均住院费用、病员流向结构及疾病对家庭和对社会的危害等因素,设计了四套补偿方案。一级、二级和三级医疗机构的起付线分别是100元、300元和500元,封顶线均为6万元。不同级别医疗机构不同病种设定不同的补偿比例。通过实证研究和评价,结果显示方案2的效果最好,住院实际补偿率达到49.68%,补偿资金达到住院统筹基金的99.44%。方案2的具体情况是：肿瘤、传染病、住院分娩、次均住院费用高(≥1000元)的病种、次均住院费用低(<1000元)的病种在一级医疗机构的补偿比率分别为85%、80%、55%、75%、70%,在二级医疗机构分别为80%、75%、65%、70%、65%,在三级医疗机构分别为70%、65%、70%、60%、55%。
(5)建立了方便实用的补偿费用测算模型
结论
(1)参合农民的住院服务利用水平较高,育龄期妇女、15岁以下和60岁以上的参合农民是住院卫生服务的重点人群；参合农民住院原因以感染性疾病为主(呼吸系统、消化系统、泌尿系统),但同时慢性非传染病(循环系统疾病)的患病率明显增加。
(2)性别、年龄、住院天数、医疗机构的级别、地区经济水平和病种是住院费用的影响因素。
(3)湖南省新型农村合作医疗自2003年试点以来参合率逐年提高,但参合积极性还有待进一步提高。筹资水平偏低,基金使用率稍低于政策规定要求,部分县市基金沉淀过多。受益面窄,多数参合农民不能受益；补偿率偏低,农民受益度不高；补助水平不平衡,多数县市合作医疗减轻农民医疗负担的作用和效益还没有充分发挥出来。但补助人次流向和补助资金分布总体上比较合理,主要集中在乡、县级医疗机构。
(4)针对新农合运行现状,因地制宜的探讨科学合理的费用补偿方案,制定合理的起付线、封顶线和不同级别医疗机构、不同病种的补偿比例,能充分发挥合作医疗基金的补偿效益,又能促使医疗卫生资源的合理利用和分配。通过费用补助减轻农民因病就医的费用负担至关重要。
(5)本研究建立的补偿费用测算模型是方便和实用的。实证研究证实,在现有的筹资水平下,本研究提出的补偿方案2是目前最科学和合理的方案,能有效发挥合作医疗基金的保障作用。
Objectives
An investigation on the operation of the New Rural Cooperative Medical System (NRCMS) in Hunan was made to obtain relevant data and further analyze the status including existing problems of NRCMS in Hunan, rural residents'health status, hospitalization expenses and the influencing factors in order to explore the possible solutions for the problems in NRCMS and provide the basis for reasonable allocation of the health resources in Hunan to promote the sustainable development of NRCMS.
Methods
With multistage clusters random sampling, one county (city and district) from each of 11 prefectures in Hunan where NRCMS pilot programs were implemented was randomly selected to build the study sample. Data analysis was used for the study of NRCMS participants' hospitalization, reimbursements by the NRCMS fund and design of the reimbursement scheme. Detailed information is as follows:1) Descriptive analysis was used for the demographical data and hospitalization of the sample and chi-square test was used for comparison of the quantitative data of two and more groups; 2) single factor and ordinal multi-category logistic regression model was used for analysis of NRCMS participants' hospitalization expenses and the influencing factors; 3) descriptive analysis was used for the operation of the NRCMS fund in the sampled counties in Hunan in 2006, including financing, fund utilization and reimbursement and fund distribution; 4) based on the above study and in combination of the NRCMS policy a reasonable expense reimbursement scheme was designed and a model of expense reimbursement calculation was established. Meanwhile an empirical study on them was made.
Results
NRCMS was implemented in forty-three counties (cities and districts) in Hunan, covering a population of about 24,635,000 rural residents, among which about 18,572,000 joined in NRCMS and the average participation rate was 75.39%. Eleven counties (cities and districts) were chosen with a total of 694,376 participants, among which 365,014 (52.57%) were men and 329,362 (47.43%) women.
1) Analysis of hospitalization service. The average hospitalization rate in the NRCMS contracted hospitals was 7.02%; the hospitalization rates in Sangzhi, Shuangpai, Huitong, Shimen and Yueyang were high:11.93%、10.57%、.80%、.26%、7.23%, respectively; women participants'hospitalization rate was higher than men's:8.01% and 6.13%, respectively; The distribution of the hospitalization rate of the participants at different age was like the letter V:the hospitalization rate of the group of 15-29 years old was the lowest (4.29%) and of the group of aged 60 and above was highest (12.96%); the top five diseases of the hospitalization rate were respiratory system diseases (22.91%), digestive system diseases (16.77%), urinary and reproductive system diseases (10.20%), poisoning and injury (9.6%), circulation system diseases (8.44%); The analysis of the distribution of hospitalized patients showed that 67.67% of the NRCMS participants were hospitalized in township medical institutions.
2) Analysis of hospitalization expense. The analysis of hospitalization expenses through single factor and ordinal multi-categroy logistic regression analysis showed that all six variables including gender, age, days of hospitalization, level of hospitals, economic level of the counties and types of diseases influenced hospitalization expenses. The average hospitalization expense per visit for men was higher than that for women; The hospitalization expense increased as age increased:The hospitalization expense per visit for the group of the age below 15 was the lowest:1038.12 yuan while the hospitalization expense per visit for the group of above 60 years old was highest:2017.17 yuan; The duration of hospitalization was positively correlated with hospitalization expense:the longer the duration of hospitalization was, the higher the hospitalization expense per visit was; the higher the level of the hospitals were, the higher the hospitalization expense per visit were; hospitalization expense per visit in the contracted provincial hospitals was highest:9070.67 yuan, and hospitalization expense per visit in township hospitals was lowest:781.52 yuan; hospitalization expense was related with the economic development level in the county:hospitalization expense per visit in the county of the high economic development level was highest: 2311.20 yuan, the hospitalization expense per visit in the county of the low economic development level was lowest:1249.16 yuan. Ordinal multi-categroy logistic regression analysis showed that hospitalization expense per visit for tumor was highest, that for congenital anomaly, screening and postoperative radio chemotherapy and rehabilitation, neural and behavioral disorder, and perinatal diseases took the second place, that forrespiratory system diseases, ear and mastoid diseases,dermatological and subcutaneous tissue diseases was lowest.
3) Operation of NRCMS in the sampled counties (cities) in Hunan in 2006. The total of raised fund was 33,086,000 yuan, among which NRCMS participants made contribution of 6,943,800 yuan,20.9% of the total fund, and public finance at all levels paid 26,142,300 yuan as allowance,79.01% of the total fund. The total of fund used for hospitalization reimbursement was 25,109,500 yuan, which is 75.89% of the total of raised fund, and 48,500 visits were reimbursed for hospitalization expense. The beneficiary rate was 6.98%. The beneficiary rates of Sangzhi, Shuangpai, Huitong, Shimen, and Yueyang were higher than the average provincial beneficiary rate. The beneficiary rates of Sangzhi and Shuanpai were highest:11.87% and 10.52%, respectively; the beneficiary rates of Wangcheng, Huayuan, Yanling, Xiangxiang, Guiyang and Changning were lower than the average provincial beneficiary rate; the beneficiary rate of Changning was lowest:3.19%. The actual hospitalization expense that the NRCMS participants paid was 83,442,200 yuan, reimbursement was 25,109,500 yuan; hospitalization expense per visit was 1711.25 yuan, and the expense per visit that could be reimbursed was 1492.61 yuan, reimbursement for each visit was 514.95 yuan, and the average provincial reimbursement rate was 30.09%. The reimbursement rates of Sangzhi, Shimen, Changning, Huayuan, and Huitong were higher than the average provincial reimbursement rate while the reimbursement rates of the other 6 counties (cities) were lower than the average provincial reimbursement rate. The highest and the lowest reimbursement rates were that of Huayuan (38.68%) and that of Xiangxiang (22.16%), respectively. In the year 2006 hospitalization reimbursement mainly concentrated on the hospitalizations in township and county hospitals that consisted of 86.99% of the reimbursed visits. Correspondingly, the proportion of the reimbursement for hospitalization in township and county hospitals was fairly big, but disproportionate. The reimbursement for hospitalization in the township hospitals consisted of 60.63% of the total reimbursed visits, but the proportion of reimbursement distribution was 39.32%. The reimbursement for hospitalization in county hospitals consisted of 26.36% of the total reimbursed visits, but the proportion of reimbursement distribution was 35.13%. There were difference among reimbursed visits and reimbursement distribution in the counties (cities) and the proportion of some counties'hospitalizations that went to prefecture level and provincial hospitals was fairly big.
4) Design of expense reimbursement scheme. According to the basic principles of the calculation of the NRCMS fund, that is, "payout depends on income and balance of payments", and based on the payment system of "deductible coverage plus coinsurance and ceiling" major considerations was given to NRCMS participation rate, the total of hospitalization co-ordination fund, rate of hospitalization, hospitalization expense per visit in the hospitals at all levels, patient distribution, and harm done to family and society by diseases and other factors. Four reimbursement schemes were designed. The deductible coverage for the medical institutions at the first, second and third levels were 100 yuan,300 yuan, and 500 yuan, respectively and the ceiling for all was 60,000 yuan. A specific proportion of reimbursement for the expenses for specific diseases in the hospitals at different level was designed. The results of the empirical study and evaluation showed that the 2nd scheme was the best:the rate of hospitalization reimbursement was actually 49.68% and the reimbursed expense was 99.44% of the hospitalization fund. The 2nd reimbursement scheme was as follows: the rate of reimbursement for the hospitalization expense for tumor, infectious diseases, delivery, diseases with average hospitalization expense per visit of one thousand yuan or more, and diseases with average hospitalization expense per visit of less than one thousand yuan were 85%,80%,55%,75% and 70%, respectively in the hospitals at the first level; 80%,75%,65%,70%and 65%, respectively in the hospitals at the second level; 70%,65%,70%, 60% and 55%, respectively in the hospitals at the third level.
5) A convenient and practical model of expense reimbursement calculation was made:M=N×ΣPij×Eij×Rij×(1+F) (i=1,2,3,j=1,2,3,4,5).
Conclusions
The following conclusions have been drawn in the study:
1) The utilization level of hospitalization service by NRCMS participants was high, and women of childbearing age, and participants of 15 years and below, and 60 years and above were the key population of hospitalization service; the majority of the diseases for which the NRCMS participants were hospitalized were infectious diseases (of respiratory system, digestive system and urological system). But at the same time prevalence of chronic non-infectious diseases increased obviously.
2) The influencing factors for hospitalization expense included gender, age, days of hospitalization, level of hospitals, economic level, and type of disease.
3) The participation rate of NRCMS in Hunan increased annually ever since the pilot program of NRCMS started in Hunan in 2003. The enthusiasm for participation in NRCMS needs to be further promoted. The level of financing was low. The rate of use of NRCMS fund was slightly lower than that required in the policy and too much surplus was left over. The majority of the NRCMS participants did not benefit from the fund; the rate of reimbursement was low; the level of reimbursement was not balanced so that the role and effect NRCMS in many counties (cities and districts) played in reducing medical burden was not achieved. However, the reimbursed visits to hospitals and distribution of reimbursement were generally reasonable, mainly concentrated on township and county medical institutions.
4) To explore a scientific and reasonable expense reimbursement scheme according to the conditions in specific counties (cities and districts), to set up deductible coverage, ceiling and the proportion of reimbursement for hospitals at different levels and for specific type of diseases can help maximize the reimbursement effect of NRCMS and facilitate the reasonable use and allocation of health resources. It is vital that the burden of farmers'medical expense be reduced through reimbursement.
5) The model of expense reimbursement calculation made in this study was convenient and practical. It was proved in the empirical study that the 2nd reimbursement scheme established in the study was most scientific and reasonable so far for the present level of NRCMS financing.
引文
[1]胡锦涛.高举中国特色社会主义伟大旗帜,为夺取全面建设小康社会新胜利而奋斗-在中国共产党第十七次全国代表大会上的报告.2007年12月.http://news.xinhuanet.com/newscenter/2007-10/24/content_6938568.htm
[2]国家统计局.2005年全国1%人口抽样调查主要数据公报.2006年3月.http://www.stats.gov.cn/tjgb/rkpcgb/qgrkpcgb/t20060316_402310923.htm.
[3]省合作医疗办.湖南省2007年新型农村合作医疗新增试点县市区培训教材-新型农村合作医疗宣传发动与筹资.2006年9月.
[4]郭士征.社会保障学[M].上海：上海财经大学出版社,2004：158.
[5]方鹏骞,张莉.国外医疗保障制度对完善中国医疗保障体系的启示.医学与社会,2008,21(11)：9-11.
[6]世界银行.《1993年世界发展报告：投资于健康》[R].北京：中国财政经济出版社,1993：210-211.
[7]World Bank.World Development Report 1993:Investing in Health (Washington, DC:World Bank,1993),P111.
[8]Kenneth W. Newell.Health By The People.Geneva:World Health Orgnization,1975.
[9]World Health Organization.Primary Health Care[R].Report of the International Conference on Primary Health Care. Geneva:WHO,1978.
[10]中国农村健康保险实验项目研究组.中国农村健康保险实验研究工作报告[J].中国卫生事业管理,1994,(2)：74.
[11]系列研究课题组.农村合作医疗保健制度的系列研究[J].中国卫生经济,1988,7(4)：13-19.
[12]中国农村医疗保健制度研究课题组.中国农村医疗保健制度研究[M].上海：上海科学技术出版社,1991.
[13]张朝阳,杨辉,叶宜德.中国农村合作医疗改革技术总报告[J].中国农村卫生事业管理,1998,18(4)：11-20.
[14]汪时东,叶宜德.农村合作医疗制度的回顾与发展研究[J].中国初级卫生保 健2004,18(4)：10-12.
[15]龚向光、胡善联、程晓明.贫困地区政府和集体在合作医疗筹资中的作用[J].中国卫生事业管理,1998,(10)：516-517.
[16]顾杏元.中国贫困农村医疗保健制度社会干预试验研究[M].上海：上海医科大学出版社,1998：17.
[17]吴仪.全面推进新型农村合作医疗发展[J].求是,2007,(6)：18-22.
[18]顾昕.当代中国农村医疗体制的变革与发展趋向[J].河北学刊.2009,29(3)：1-6.
[19]中国网.新型农村合作医疗制度的建立和发展http://www.china.com.cn/ news/txt/2007-06/01/content 8329082.htm
[20]李爽,张文波.我国社会保障现状及政策建议[J].中国经贸导刊,2008(21)：35-37.
[21]2008年中国卫生十大新闻揭晓http://www.yxxyy.com/read/info/content. asp?id=2220
[22]蒋中一.农村合作医疗制度的发展和取得的成效[J].红旗文稿,2008(9)：8.
[23]中国乡村发现网.年度报告：湖南新型农村合作医疗制度建设的调查报告http://www.168nong.cn/2010/0304/191258_2.html
[24]湖南省农村合作医疗信息网.湖南省新农合制度建设6年结硕果-湖南省新农合制度建设6年成果展示和前景展望.http://www.hnhzyl.cn/hzyl_ wz.asp? wzid=1074
[25]刘雅静.对我国新型农村合作医疗筹资问题的几点探讨[J].华南农业大学学报(社会科学版),007,(3)：10-14.
[26]刘军民.农村合作医疗存在的制度缺陷[J].华中师范大学学报(人文社会科学版),2006,45(2)：32-36.
[27]王列军,葛延风.农村医疗保障制度建设需全面调整思路[N].中国经济时报,2005年6月.
[28]史慧.新型农村合作医疗补偿模式的实证分析及评价[D].首都经济贸易大学：2008
[29]萧庆伦,汪宏,王禄生,高建民,张里程,薛秦香.中国农村互助医疗[J].中国卫 生经济,2004,23(7)：5-8.
[30]全国政协十一届二次会议提案第0167号：关于完善新型农村合作医疗体系的提案http://cppcc.people.com.cn/GB/34961/161082/9666607.html
[31]王燕.山东省新型农村合作医疗补偿机制研究新农合补偿机制研究[D].山东大学：2007.
[32]王靖元.新农合滚动筹资理论与实践[M].北京：北京大学医学出版社,2006.
[33]卫生部,财政部.关于完善新型农村合作医疗统筹补偿方案的指导意见.卫农卫发[2007]253号。
[34]我国新型农村合作医疗补偿模式将确立http://www.21 nong.com/news/html/2008/08/20080820140935-1.htm
[35]胡喜联,新型农村合作医疗的研究方向[J].为什么经济研究,2004,(6)：23-26.
[36]王靖元,邵高泽.论新型农村合作医疗基金分割机制与补偿比例[J].中国农村卫生事业管理,2005,25(7)：19-21.
[37]方黎明,顾昕.突破自愿性困局：新型农村合作医疗中参合的激励机制与可持续发展[J].中国农村观察,2006,(4)：24-34.
[38]刘启栋.认同尴尬折射制度缺陷---漫谈新型农村合作医疗的制度缺陷及对策[J].中国卫生经济,2005,(5)：3-7.
[39]吴明,王延中.《发展中的中国新型农村合作医疗》[M].北京：人民卫生出版社,2006：34-39
[40]周海沙,李卫平.新型农村合作医疗实际运行中的问题探讨[J].中国卫生经济,2005,24(5)：5-8.
[41]杨立雄,刘湘玲.对新型农村合作医疗试点中需要解决的几个问题[J].社会科学研究,2006,(2)：112-118.
[42]卫生部.全国新型农村合作医疗试点工作取得明显成效Http://www.moh.gov.cn/public/open.aspx?n-id= 10507&seq=0.
[43]潘传旭,杨树勤.医疗费用的预测模型[J].中国卫生事业管理,1987,(10)：13.
[44]李良军.保险因子的初步研究[J].中国卫生事业管理,1994,(4)：13.
[45]李良军.医疗费用预测模型及保险因子分析[J].中国卫生事业管理,1994, (4)：235.
[46]李良军.农村健康保险的精算体现[J].现代预防医学,1994,(5)：69.
[47]李良军,杨树勤,刘关键,等.医药费用补偿比的测算[J].中国卫生事业管理,1994,(7)：344-346.
[48]陈烈平.一种合作医疗筹资与补偿平衡点的测算方法[J].中国农村卫生事业管理,1997,17(9)：9-11.
[49]傅卫,范文胜,王禄生.合作医疗基金分配与补偿比测算[J].中国卫生经济,1998,17(2)：43-45.
[50]马安宁,管廷羡,陈宁珊.风险型合作医疗的研究[J].中华医院管理杂志,1998,15(4)：213-215.
[51]成昌惠,刘兴柱,黄思桂等,关于由起保点、止保点实行分段补偿的合作医疗筹资测算模型研究[J].中国初级卫生保险,1997,11(11)：6-8.
[52]张里程,汪宏,江启成.合作医疗基金分配与补偿比测算[J].中国农村卫生事业管理,1996,16(12)：41-46.
[53]董有方,刘可.新型农村合作医疗住院补偿方案的制定[J].中国卫生事业管理,2003,(11)：697-689.
[54]徐锡武,彭芳,王蓉等.湖北省新型农村合作医疗试点县医院住院费用构成分析[J].华中科技大学学报(医学版),2004,33(3)：372-275.
[55]薛赛峰,郭忠琴,井树礼等.宁夏回族自治区新型农村合作医疗费用测算研究[J].中国卫生经济,2005,24,(3)：15-17.
[56]阿木都克里木,阿依古丽,翟群.新疆新型农村合作医疗“分级、分段计算,累加支付”测算方法研究[J].中国农村卫生事业管理,2005,25,(11)：9-11.
[57]田庆丰,需卫河,刘新奎.新型农村合作医疗试点县农民医疗费用分析和补偿比例测算[J].郑州大学学报(医学版),2005,40(5)：848-850.
[58]俊安.运用样本均数和样本期间患病率预测新型农村合作医疗基金运行的研究[J].中国农村卫生事业管理,2005,(7)：15-16.
[59]王小万,刘丽杭.新型农村合作医疗住院补偿比例与起付线的实证研究[J].中国卫生经济,2005,24,(3)：12-14.
[60]王卉晓.安徽省新型农村合作医疗费用补偿方案分析评价[J].中国卫生资 源,2006,9(1)：36-38.
[61]赖洁莲.中外农村医疗保险模式比较分析[J].“三农”问题研究,2004,(7)：166-168.
[62]Health insurance. http://en.wikipedia.org/wiki/Health_insurance# United_Kingdom.
[63]Health care system. http://en.wikipedia.org/wiki/Health_care_ compared# United_Kingdom
[64]《湖南统计年鉴—2007》http://www.hntj.gov.cn/sjfb/tjnj/07tjnj/img
[65]周玉翠.湖南省区域经济差异及区域经济发展对策研究[J].地理学与国土研究,2000,16(3)：52-56.
[66]《2008年中国卫生统计年鉴》http://www.moh.gov.cn/publicfiles/ business/htmlfiles/mohbgt/s8274/200809/37759.htm
[67]董景五.疾病和有关健康问题的国际统计分类(第10次修订)(2版)第2卷[M].北京：人民卫生出版社,2003.
[68]湖南省财政厅、卫生厅.湖南省新型农村合作医疗基金财务管理办法.湘财社[2008]16号,2008年5月
[69]省财政厅.湖南省2007年新型农村合作医疗新增试点县市区培训教材-新型农村合作医疗基金管理.2006年9月.
[70]蔡善荣,阮红芳,李鲁,等.以主成分回归分析方法探讨人均卫生费用影响因素的研究[J].中国卫生事业管理.2001,(7)：399-400.
[71]杨辉,张硕.合作医疗补偿方式及水平的研究[J].中国农村卫生事业管理,1998,18(4)：44-51.
[72]湖南省新型农村合作医疗协调领导小组.《关于完善新型农村合作医疗补偿方案的指导意见》.湘合医组字[2008]4号,2008年6月.
[73]省卫生厅.湖南省2007年新型农村合作医疗新增试点县市区培训教材-新型农村合作医疗费用测算.2006-9.
[74]湖南省新型农村合作医疗协调领导小组文件,湘合医组字[2009]3号：关于进一步调整完善新农合补偿方案的指导意见2009-11-12
[75]卓朗,谷玉明,陈国庆,等.江苏省新型农村合作医疗参合率多因素分析[J]. 中国农村卫生事业管理2007,27(11)：809-811.
[76]杨艳,杨文选.新型农村合作医疗农民参与意愿的影响因素分析[J].农村经济.2007,12：71-73.
[77]刘文,伍林生.对解决新型农村合作医疗农民逆向选择问题的探索[J].农村经济.
[78]科尔奈,翁笙和.转轨中的福利、选择和一致性：东欧国家卫生部门改革.罗淑锦译[M].第一版,北京：中信出版社,2003.
[79]卫生部办公厅.第四次国家卫生服务调查主要结果http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s3582/200902/39 201.htm
[80]卫生部办公厅.卫生部公布2003年进行的第三次国家卫生服务调查结果.http://www.china.com.cn/zhuanti2005/txt/2004-12/03/content_5719473.htm
[81]詹小海,潘宝骏.福建省2007年参加新型农村合作医疗农民疾病负担及医疗费用分析[J].华南预防医学.2008,34(5)：52-55.
[82]杨立雄,刘湘玲.对新型农村合作医疗基金几个问题的思考[J].湖南师范大学社会科学学报,2006,35(2)：12-17.
[83]阳秋林,唐建华,刘豪,等.刍论湖南省农村最低生活保障标准的确定[J].南华大学学报(社会科学版),2008,9(2)：40-42.
[84]徐润龙,叶真,曾国经,等.浙江省三县新型农村合作医疗方案对解决“因病致贫”问题的作用评价[J].中国卫生经济,2006,25(4)：36-37.
[85]毕兆荣,罗美芳,谈永奇.2006年住院病人医疗费用及影响因素分析[J].中国病案.2008,9(3)：18-19.
[86]施红英,沈毅,何凡.多水平模型在住院费用影响因素分析中的应用[J].2006,23(5)：397-399.
[87]苗丽琼,李江玲.住院病人系统疾病医疗费用的因子分析[J].中国医院统计,2006,13(3)：11-13.
[88]肖锦铖.合肥地区不同人群住院费用结构分析与期望调查[J].中国医院管理.2003,23(2)：17-20.
[89]何平平.我国医疗费用增长因素的计量分析[J].太平洋学报,2005,11：25-31.
[90]曹志辉,韩彩欣,张倩,等.沧州市住院患者医疗费用影响因素分析[J].中国医院管理.2007,27(2)：17-20.
[91]Nicolal JP.Budget caps and the quality of health care in Holland.Plast Reconstr Surg,1996,96(4):964-965.
[92]袁永林.军队卫生统计工作手册[M].北京：人民军医出版社,2002：64-66.
[93]候兆红,毕润芝.患者住院日与医疗费用比例的统计与分析[J].中国医院统计,2005,12(6)：167-168.
[94]马华.浅谈平均住院日[J].中国卫生统计,2005,22(4)：269.
[95]Holloway,RG,Witter,DM,Lawtan,KB.Inpatient costs of specific cerebrovascular events at five academic medical centers[J]. Neurology,1996,46 (3):854.
[96]于德志.健全医疗保障制度是解决看病难看病贵的重要途径[J].中华医药管理杂志,2006,22：73-76.
[97]李贝,毛宗福,李建平,等.湖北省居民住院费用影响因素分析[J].中国卫生事业管理,2005(8)：483-485.
[98]杨金侠.新型农村合作医疗农村定点医疗机构费用控制模型与实现机制研究[D].山东大学：2007.
[99]程念,付晓光,汪早立.2006年东部地区新型农村合作医疗运行情况分析[J].中国卫生经济,2008,27(8)：38-40.
[100]左延莉,胡善联,傅卫,等.2004年全国新型农村合作医疗资金使用情况分析[J].中华医院管理杂志,2006,22(11)：765-768.
[101]曹志辉,韩彩欣,张倩,等.沧州市住院患者医疗费用影响因素分析[J].中国医院管理,2007,27(2)：17-20.
[102]人民日报.中国新农合医疗：看病费用降低监管力度决定成败.http://www.fm120.com/content/2007-5/21/94029.html
[103]郝双英.影响农民参加新型农村合作医疗积极性的因素分析[J]卫生软科学,2006,20(2)：105-106.
[104]省合作医疗办.湖南省2007年新型农村合作医疗新增试点县市区培训教材-新型农村合作医疗实施方案设计.2007年9月.
[105]王芹萼.我国农村合作医疗制度运行机制研究[D].华中科技大学：2006
[106]孙标.新型农村合作医疗运行机制研究-以江阴市为例[D].南京师范大学：2008.
[107]陈虹,王新星.我国新型农村合作医疗运行机制研究[J].现代商贸工业,2009(13)：45-46.
[108]张磊,贺雪娇.剖析新型农村合作医疗制度的筹资意愿与能力[J].农村经济,2007,(5)：79-81.
[109]林存友.新农合基金运行中存在的问题及对策研究[J].中国乡镇企业,2009(1)：59-60
[110]吴燕、顾海.完善新型农村合作医疗管理运行机制的探讨[J].中国农村卫生事业管理,2007,27(11)：806-808.
[111]张英洁,李士雪.全国新型农村合作医疗试点运行状况分析[J].中国卫生事业管理,2008,(7)：481-482,491.
[112]韩俊、罗丹.中国农村卫生调查[M].上海：上海远东出版社,2007：1-522.
[113]湖南省新型农村合作医疗信息.湘潭市2007年1-9月份新型农村合作医疗基金运行情况分析报告.http://xt.hnhzyl.cn/show.asp?m_id=32&id=1893
[114]魏欣芝.新型农村合作医疗基金运行机制研究-以山东省为例[D].山东农业大学,2008.
[115]湖南省卫生厅.湖南省卫生厅关于印发《湖南省新型农村合作医疗基本药品目录(2010年版)》的通知.湘卫合医发[2010]1号.
[116]唐立健.新型农村合作医疗筹资水平和补偿方案的研究[D].东南大学：2006.
[117]唐松源,李迅,崔文龙,等.云南省弥渡县新型农村合作运行补偿机制研究[J].中国公共卫生,2006,22(3)：261-263.
[118]黄余送,杨善发.新型农村合作医疗基金管理模式探索[J],湖北社会科学,2007,(9)：60-62.
[119]左树岩,鞠秀荣.探索合作医疗制度下的大病补偿比[J].卫生经济研究,2001(13)：14-16.
[120]中国政府网.2009年湖南省农民人均纯收入实现连续六年增长.http:// www.china.com.cn/rollnews/2010-01/31/content 379412.htm
[121]仇雨临.医疗保险[M].中国人民大学出版社,2001.
[122]郑莹,李德绿,俞顺章,等.上海市恶性肿瘤疾病负担的研究[J].中国肿瘤,2001,10(4)：196-198.
[123]周守君,胡晓抒,钱颐等.南京市雨花台区肿瘤死亡疾病负担研究—疾病诊治需求与经济损失分析[J].中国卫生经济,2008,27(12)：52-55.
[124]陈启军,陈越,杜生明.论传染病的危害及我国的防治策略[J].中国基础科学,2005,7(6)：19-30.
[125]陈启军.论传染病的危害及我国的防治策略.中国人兽共患病学术研讨会论文集：13-19.
[126]湖南省卫生厅.关于《湖南省农村孕产妇住院分娩补助指导方案(试行)》的具体操作说明.湘卫合医函[2009]3号.2009年3月25日.
[127]王小合,严光府,曾国经等.浙江省新型农村合作医疗基金运行状况分析[J].中国初级卫生保健,2008,22(1)：27-31.
[128]Lynch WD. RO I Bullseye:demonstrating results with population health management[J].Absolute Advantage-The Workp lace Wellness Magazine, 2003,(2):20-50.
[129]陈君石,李明.个人健康管理在健康保险中的应用现状与发展趋势[J].中华全科医师杂志,2005,4(1)：30-32.
[130]杜乐勋,武广华,朱玉久,等.医院单病种付费概念与内容、历史和现状以及政策建议[J].中国医院管理,2007,27(9)：23-25.
[131]刘运国,傅卫,姚岚,等.论新型农村合作医疗制度中按病种付费制度的发展策略[J].中国医院管理,2007,27(8)：28-29.
[132]张歆,王禄生.按病种付费在我国新型农村合作医疗试点地区的应用[J].卫生经济研究,2007,2：20-21.
[133]李慧萍.湖南省新型农村合作医疗费用控制研究[D].国防科学技术大学：2007.
[1]景琳.农村合作医疗实用手册[M].四川：四川科技出版社,1998.6
[2]World Bank, World Development Report 1993:Investing in Health. (Washington, DC:World Bank,1993), P.111.
[3]Kenneth W. Newell. Health By The People. Geneva:World Health Orgnization,1975.
[4]World Health Organization. Primary Health Care[R]. Report of the International Conference on Primary Health Care. Geneva:WHO,1978.
[5]张自宽.让合作医疗遍地开花[N].健康报,1958年9月
[6]张自宽.积极推行集体保健医疗制度[N].健康报,1960年5月
[7]张自宽.如何巩固和办好合作医疗——黄岗地区合作医疗座谈会纪要[N].卫生部湖北农村卫生工作队简报(第1期),1966年6月.
[8]张自宽.农村合作医疗应该肯定应该提倡应该发展[J].农村卫生事业管理研究,1982,(2)：31-33
[9]世界银行.中国：卫生模式转变中的长远问题与对策[C].北京：中国财政经济出版社,1994.
[10]中国农村健康保险实验项目研究组.中国农村健康保险实验研究工作报告[J].中国卫生事业管理,1994,(2)：74
[11]系列研究课题组.农村合作医疗保健制度的系列研究.中国卫生经济,1988,7(4)：13-19.
[12]中国农村医疗保健制度研究课题组.中国农村医疗保健制度研究.上海：上海科学技术出版社,1991.
[13]张朝阳,杨辉,叶宜德.中国农村合作医疗改革技术总报告[J].中国农村卫生事业管理,1998,18(4)：11-20
[14]汪时东,叶宜德.农村合作医疗制度的回顾与发展研究[J].中国初级卫生 保健2004,18(4)：10-12.
[15]龚向光、胡善联、程晓明.贫困地区政府和集体在合作医疗筹资中的作用[J].中国卫生事业管理,1998,(10)：516-517
[16]顾杏元.中国贫困农村医疗保健制度社会干预试验研究.上海：上海医科大学出版社,1998.17
[17]张自宽.对合作医疗早期历史情况的回顾[J].中国卫生经济,1992,11(6)：21-23。
[18]李德成.中国农村传统合作医疗制度研究综述[J].华东理工大学学报(社会科学版),2007,(1)：19
[19]夏杏珍.农村合作医疗制度的历史考察[J].当代中国史研究,2003,10(5)：111
[20]曹普.改革开放前中国农村合作医疗制度[J].当代中国史研究.2007.(01)：142-143
[21]张自宽.关于我国农村合作医疗保健制度的回顾性研究[J].中国农村卫生事业管理.1994,14(6)：4-9
[22]张自宽.在合作医疗问题上应澄清思想统一认识[J].中国农村卫生事业管理,1992,(6)：8-10
[23]全国政协医药卫生体育委员会.关于农村卫生工作调查报告[J].中国卫生质量管理,1995,(3,4)：8
[24]顾涛,石俊仕,郑文贵,单杰.农村医疗保险制度相关问题分析及政策建议[J].中国卫生经济,1998,17(4)：42-43
[25]课题组.中国农村卫生服务筹资和农村医生报酬机制研究[J].中国初级卫生保健,2000(7)：3-10
[26]Shan Cretin, Albert P. Williams, Jeffrey Sine, "China Rural Health Insurance Experiment:Final Report, " RAND Health Working Papers, WR-411, August 2006.
[27]袁木,陈敏章.加快农村合作医疗保健制度的改革和建设[J].中国农村卫生事业管理,1994,14(9)：1-4.
[28]卫生部医政司.农村合作医疗出现了良好发展势头[J].中国农村卫生事业
管理,1997,(2)：13
[29]马振江.试论有中国特色的农村初级卫生保健体系[J].中国卫生经济,2000,(5)：51-52
[30]王延中.论新世纪中国农民医疗保障问题[J].战略与管理,2001,(3)：15-24
[31]聂妍,饶延华,周俊,冯聪,杜玉开.我国新型农村合作医疗制度的发展现状[J].中国社会医学杂志,2009,26(5)：263-264
[32]毛正中.规范和完善新型农村合作医疗制度[N].人民日报,2008-7-8
[33]刘军民.农村合作医疗存在的制度缺陷[J].华中师范大学学报(人文社会科学版),2006,45(2)：32-36
[34]乔益洁.中国农村合作医疗制度的历史变迁[J].青海社会科学,2004,(3)
[35]顾听,方黎明.自愿与强制性之间——中国农村合作医疗的制度嵌入性与可持续发展分析[J].社会科学研究,2004,(5)：1-18
[36]韩俊,罗丹.中国农村卫生调查[M].上海：上海远东出版社,2007.52-56.
[37]刘华,何军.中国农村医疗保障体系的经济学分析[J].农业经济问题,2006,(4)：14.
[38]胡鞍钢,胡琳琳.中国宏观经济与卫生健康[J].改革,2003,(2)：31.
[39]韩俊,罗丹.中国农村医疗卫生状况报告[J].中国发展观察,2005,1(1)：12-21
[40]张元红.农村公共卫生服务的供给与筹资[J].中国农村观察,2004,(5)：50-59
[41]World Health Organization. The World Health the Report 2000. Geneva: World Health Organization.
[42]Hossain S. I. Tackling Health Transition in China[R]. The World Bank, 1997,55.
[43]Bogg L. Health Care Financing in China:Equity in Transition [M]. Stockholm:Karolinska University Press, Division of International Health, Departmentof Public Health Sciences,2002:78-79.
[44]平新乔.从中国农民医疗保健支出行业看农村医疗保健机制的选择[J]. 管理世界,2003,(11)：34-36.
[45]朱玲.农村医疗救助项目的效果[J].经济学动态,2006,(8)：51.
[46]林闽钢.我国农村合作医疗制度治理结构的转型[J].农业经济问题,2006,(5)：24.
[47]侯剑平,邱长溶.健康公平理论研究综述[J].经济学动态,2006,(7)：44.
[48]湖南财政厅社会保障处调研课题组.湖南省新型农村合作医疗制度建设的调查报告.http://www.51Labour. com.2009-6-24
[49]Haltom C. Health risk management:well-being for the employee and the bottom line [J]. Benefits Q,2005,21(3):7-10.
[50]赵立飞.六种合作医疗筹资方法的比较[J].中国初级卫生保健,2006,20(8)：4-6.
[51]江启成,叶宜德,秦其荣,汪时东等。新型农村合作医疗农民个人筹资方式现况研究,中国卫生经济2006,25(12)：22-23
[52]刘雅静.对我国新型农村合作医疗筹资问题的几点探讨[J].华南农业大学学报(社会科学版),2007,(3)：10-14
[53]张磊,贺雪娇.剖析新型农村合作医疗制度的筹资意愿与能力[J].农村经济,2007,(5)：79-81
[54]王成艳,薛兴利.关于农村合作医疗筹资机制的探讨[J].卫生经济研究,2005,(1)
[55]胡善联.卫生经济学[M].上海：复旦大学出版社,2003.154
[56]轩志东.卫生经济改革理论研究与实践[M].北京：石油工业出版社,2001.243-246
[57]刘爱华.新形势下对农村卫生几个问题的看法[J].卫生工作通讯,1995,(3)：207
[58]王列军,葛延风.农村医疗保障制度建设需全面调整思路[N].中国经济时报,2005-06-07.
[59]杨金侠,江启成,王章泽,温丽娜.新型农村合作医疗医疗费用控制实证研究：不合理医疗费用控制模型与实施方略[J].中国卫生经济,2009,28(5)：14-16
[60]Links Beaty L. Understanding diagnostic related groups (DRGs) and inpatient hospital reimbursement [J]. Gastroenterol Nurs,2005,28 (5):363-371.
[61]Links Smith JJ, Maida A,Henderson JA. Hospital outpatient prospective payment under medicare:Understanding the system and its implications [J]. Radiology,2002,225(1):13-22.
[62]卫生部统计信息中心.第三次国家卫生服务调查分析报告[R].北京：中国协和医科大学出版社,2004.
[63]左延莉,胡善联,傅卫,江芹.全国新型农村合作医疗试点现况研究[J].中国卫生资源,2006,9(3)：127-129.
[64]吴之寿.谈对医疗保险定点医院的监督管理[J].中华医院管理杂志,2001,17：281-282.
[65]苏红.医疗费用控制及相关问题研究[J].国际医药卫生导报,2005,(07)
[66]王龙兴.上海市医疗保险制度改革的实践[J].中华医院管理杂志,2000,16(5)：280-282.
[67]王靖元.新农合滚动筹资理论与实践[M].北京：北京大学医学出版社,2006.
[68]胡善联,左延莉.中国农村新型合作医疗制度的建立：成绩和挑战[J].卫生经济研究,2007,11：3-6.
[69]王兰芳,孟令杰,徐芳.新型农村合作医疗对农民影响的实证研究——以江苏的调查为例[J].农业经济问题2007,(7)：22.
[70]萧庆伦,汪宏,王禄生,高建民,张里程,薛秦香.中国农村互助医疗[J].中国卫生经济,2004,23(7)：5-8
[71]刘远立,任苒,陈迎春,胡善联,萧庆伦.中国农村贫困地区合作医疗运行的主要影响因素分析——10个县干预试验结果[J].中国卫生经济,2002,21(2)：11-16
[72]毛正中,蒋家林.如何合理制定“新农合”方案[EB/01].http: //www. cncms. org. cn/,2005-5-17.
[73]胡毅烈.新农合基金要最大限度用于农民[EB/01].http: //www. cncms. org. cn/,2005-10-8.
[74]汪长如,叶宜德.新型农村合作医疗管理模式与经办机构研究[J].中国农村卫生事业管理.2007,27(7)：491
[75]董烈军.完善新型农村合作医疗制度的思考[J].安徽农业大学学报,2006,15(7)：22-25
[76]叶宜德,张朝阳,胡善联,罗珏,汪和平.新时期农村合作医疗保障制度的基本模.http://www. cncms. org. cn/Content. asp?ID=1110&LClass_ID= 62.2004-7-9
[77]李华.新型农村合作医疗制度的制约因素与发展对策[J].求实杂志,2005,(10)：40-41.
[78]王禄生,应亚珍.新型农村合作医疗基金运行风险防范对策[J].中国卫生经济,2006,25(11)：36-38.
[79]杨金侠,李士雪.对新型农村合作医疗定点医疗机构监管的途径与程序[J].中国卫生经济,2006,25(2)：25-26.
[80]周伟,王靖元,徐德斌.新型农村合作医疗支撑要素分析[J].中国农村卫生事业管理,2005,25(11)：14-15.
[81]Ashworth M, Lea R. How are primary care organizations using financial incentives to influence prescribing [J]. J Public Health, 2004,26(1):48-51.
[2]国家统计局.2005年全国1%人口抽样调查主要数据公报.2006年3月.http://www.stats.gov.cn/tjgb/rkpcgb/qgrkpcgb/t20060316_402310923.htm.
[3]省合作医疗办.湖南省2007年新型农村合作医疗新增试点县市区培训教材-新型农村合作医疗宣传发动与筹资.2006年9月.
[4]郭士征.社会保障学[M].上海：上海财经大学出版社,2004：158.
[5]方鹏骞,张莉.国外医疗保障制度对完善中国医疗保障体系的启示.医学与社会,2008,21(11)：9-11.
[6]世界银行.《1993年世界发展报告：投资于健康》[R].北京：中国财政经济出版社,1993：210-211.
[7]World Bank.World Development Report 1993:Investing in Health (Washington, DC:World Bank,1993),P111.
[8]Kenneth W. Newell.Health By The People.Geneva:World Health Orgnization,1975.
[9]World Health Organization.Primary Health Care[R].Report of the International Conference on Primary Health Care. Geneva:WHO,1978.
[10]中国农村健康保险实验项目研究组.中国农村健康保险实验研究工作报告[J].中国卫生事业管理,1994,(2)：74.
[11]系列研究课题组.农村合作医疗保健制度的系列研究[J].中国卫生经济,1988,7(4)：13-19.
[12]中国农村医疗保健制度研究课题组.中国农村医疗保健制度研究[M].上海：上海科学技术出版社,1991.
[13]张朝阳,杨辉,叶宜德.中国农村合作医疗改革技术总报告[J].中国农村卫生事业管理,1998,18(4)：11-20.
[14]汪时东,叶宜德.农村合作医疗制度的回顾与发展研究[J].中国初级卫生保 健2004,18(4)：10-12.
[15]龚向光、胡善联、程晓明.贫困地区政府和集体在合作医疗筹资中的作用[J].中国卫生事业管理,1998,(10)：516-517.
[16]顾杏元.中国贫困农村医疗保健制度社会干预试验研究[M].上海：上海医科大学出版社,1998：17.
[17]吴仪.全面推进新型农村合作医疗发展[J].求是,2007,(6)：18-22.
[18]顾昕.当代中国农村医疗体制的变革与发展趋向[J].河北学刊.2009,29(3)：1-6.
[19]中国网.新型农村合作医疗制度的建立和发展http://www.china.com.cn/ news/txt/2007-06/01/content 8329082.htm
[20]李爽,张文波.我国社会保障现状及政策建议[J].中国经贸导刊,2008(21)：35-37.
[21]2008年中国卫生十大新闻揭晓http://www.yxxyy.com/read/info/content. asp?id=2220
[22]蒋中一.农村合作医疗制度的发展和取得的成效[J].红旗文稿,2008(9)：8.
[23]中国乡村发现网.年度报告：湖南新型农村合作医疗制度建设的调查报告http://www.168nong.cn/2010/0304/191258_2.html
[24]湖南省农村合作医疗信息网.湖南省新农合制度建设6年结硕果-湖南省新农合制度建设6年成果展示和前景展望.http://www.hnhzyl.cn/hzyl_ wz.asp? wzid=1074
[25]刘雅静.对我国新型农村合作医疗筹资问题的几点探讨[J].华南农业大学学报(社会科学版),007,(3)：10-14.
[26]刘军民.农村合作医疗存在的制度缺陷[J].华中师范大学学报(人文社会科学版),2006,45(2)：32-36.
[27]王列军,葛延风.农村医疗保障制度建设需全面调整思路[N].中国经济时报,2005年6月.
[28]史慧.新型农村合作医疗补偿模式的实证分析及评价[D].首都经济贸易大学：2008
[29]萧庆伦,汪宏,王禄生,高建民,张里程,薛秦香.中国农村互助医疗[J].中国卫 生经济,2004,23(7)：5-8.
[30]全国政协十一届二次会议提案第0167号：关于完善新型农村合作医疗体系的提案http://cppcc.people.com.cn/GB/34961/161082/9666607.html
[31]王燕.山东省新型农村合作医疗补偿机制研究新农合补偿机制研究[D].山东大学：2007.
[32]王靖元.新农合滚动筹资理论与实践[M].北京：北京大学医学出版社,2006.
[33]卫生部,财政部.关于完善新型农村合作医疗统筹补偿方案的指导意见.卫农卫发[2007]253号。
[34]我国新型农村合作医疗补偿模式将确立http://www.21 nong.com/news/html/2008/08/20080820140935-1.htm
[35]胡喜联,新型农村合作医疗的研究方向[J].为什么经济研究,2004,(6)：23-26.
[36]王靖元,邵高泽.论新型农村合作医疗基金分割机制与补偿比例[J].中国农村卫生事业管理,2005,25(7)：19-21.
[37]方黎明,顾昕.突破自愿性困局：新型农村合作医疗中参合的激励机制与可持续发展[J].中国农村观察,2006,(4)：24-34.
[38]刘启栋.认同尴尬折射制度缺陷---漫谈新型农村合作医疗的制度缺陷及对策[J].中国卫生经济,2005,(5)：3-7.
[39]吴明,王延中.《发展中的中国新型农村合作医疗》[M].北京：人民卫生出版社,2006：34-39
[40]周海沙,李卫平.新型农村合作医疗实际运行中的问题探讨[J].中国卫生经济,2005,24(5)：5-8.
[41]杨立雄,刘湘玲.对新型农村合作医疗试点中需要解决的几个问题[J].社会科学研究,2006,(2)：112-118.
[42]卫生部.全国新型农村合作医疗试点工作取得明显成效Http://www.moh.gov.cn/public/open.aspx?n-id= 10507&seq=0.
[43]潘传旭,杨树勤.医疗费用的预测模型[J].中国卫生事业管理,1987,(10)：13.
[44]李良军.保险因子的初步研究[J].中国卫生事业管理,1994,(4)：13.
[45]李良军.医疗费用预测模型及保险因子分析[J].中国卫生事业管理,1994, (4)：235.
[46]李良军.农村健康保险的精算体现[J].现代预防医学,1994,(5)：69.
[47]李良军,杨树勤,刘关键,等.医药费用补偿比的测算[J].中国卫生事业管理,1994,(7)：344-346.
[48]陈烈平.一种合作医疗筹资与补偿平衡点的测算方法[J].中国农村卫生事业管理,1997,17(9)：9-11.
[49]傅卫,范文胜,王禄生.合作医疗基金分配与补偿比测算[J].中国卫生经济,1998,17(2)：43-45.
[50]马安宁,管廷羡,陈宁珊.风险型合作医疗的研究[J].中华医院管理杂志,1998,15(4)：213-215.
[51]成昌惠,刘兴柱,黄思桂等,关于由起保点、止保点实行分段补偿的合作医疗筹资测算模型研究[J].中国初级卫生保险,1997,11(11)：6-8.
[52]张里程,汪宏,江启成.合作医疗基金分配与补偿比测算[J].中国农村卫生事业管理,1996,16(12)：41-46.
[53]董有方,刘可.新型农村合作医疗住院补偿方案的制定[J].中国卫生事业管理,2003,(11)：697-689.
[54]徐锡武,彭芳,王蓉等.湖北省新型农村合作医疗试点县医院住院费用构成分析[J].华中科技大学学报(医学版),2004,33(3)：372-275.
[55]薛赛峰,郭忠琴,井树礼等.宁夏回族自治区新型农村合作医疗费用测算研究[J].中国卫生经济,2005,24,(3)：15-17.
[56]阿木都克里木,阿依古丽,翟群.新疆新型农村合作医疗“分级、分段计算,累加支付”测算方法研究[J].中国农村卫生事业管理,2005,25,(11)：9-11.
[57]田庆丰,需卫河,刘新奎.新型农村合作医疗试点县农民医疗费用分析和补偿比例测算[J].郑州大学学报(医学版),2005,40(5)：848-850.
[58]俊安.运用样本均数和样本期间患病率预测新型农村合作医疗基金运行的研究[J].中国农村卫生事业管理,2005,(7)：15-16.
[59]王小万,刘丽杭.新型农村合作医疗住院补偿比例与起付线的实证研究[J].中国卫生经济,2005,24,(3)：12-14.
[60]王卉晓.安徽省新型农村合作医疗费用补偿方案分析评价[J].中国卫生资 源,2006,9(1)：36-38.
[61]赖洁莲.中外农村医疗保险模式比较分析[J].“三农”问题研究,2004,(7)：166-168.
[62]Health insurance. http://en.wikipedia.org/wiki/Health_insurance# United_Kingdom.
[63]Health care system. http://en.wikipedia.org/wiki/Health_care_ compared# United_Kingdom
[64]《湖南统计年鉴—2007》http://www.hntj.gov.cn/sjfb/tjnj/07tjnj/img
[65]周玉翠.湖南省区域经济差异及区域经济发展对策研究[J].地理学与国土研究,2000,16(3)：52-56.
[66]《2008年中国卫生统计年鉴》http://www.moh.gov.cn/publicfiles/ business/htmlfiles/mohbgt/s8274/200809/37759.htm
[67]董景五.疾病和有关健康问题的国际统计分类(第10次修订)(2版)第2卷[M].北京：人民卫生出版社,2003.
[68]湖南省财政厅、卫生厅.湖南省新型农村合作医疗基金财务管理办法.湘财社[2008]16号,2008年5月
[69]省财政厅.湖南省2007年新型农村合作医疗新增试点县市区培训教材-新型农村合作医疗基金管理.2006年9月.
[70]蔡善荣,阮红芳,李鲁,等.以主成分回归分析方法探讨人均卫生费用影响因素的研究[J].中国卫生事业管理.2001,(7)：399-400.
[71]杨辉,张硕.合作医疗补偿方式及水平的研究[J].中国农村卫生事业管理,1998,18(4)：44-51.
[72]湖南省新型农村合作医疗协调领导小组.《关于完善新型农村合作医疗补偿方案的指导意见》.湘合医组字[2008]4号,2008年6月.
[73]省卫生厅.湖南省2007年新型农村合作医疗新增试点县市区培训教材-新型农村合作医疗费用测算.2006-9.
[74]湖南省新型农村合作医疗协调领导小组文件,湘合医组字[2009]3号：关于进一步调整完善新农合补偿方案的指导意见2009-11-12
[75]卓朗,谷玉明,陈国庆,等.江苏省新型农村合作医疗参合率多因素分析[J]. 中国农村卫生事业管理2007,27(11)：809-811.
[76]杨艳,杨文选.新型农村合作医疗农民参与意愿的影响因素分析[J].农村经济.2007,12：71-73.
[77]刘文,伍林生.对解决新型农村合作医疗农民逆向选择问题的探索[J].农村经济.
[78]科尔奈,翁笙和.转轨中的福利、选择和一致性：东欧国家卫生部门改革.罗淑锦译[M].第一版,北京：中信出版社,2003.
[79]卫生部办公厅.第四次国家卫生服务调查主要结果http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s3582/200902/39 201.htm
[80]卫生部办公厅.卫生部公布2003年进行的第三次国家卫生服务调查结果.http://www.china.com.cn/zhuanti2005/txt/2004-12/03/content_5719473.htm
[81]詹小海,潘宝骏.福建省2007年参加新型农村合作医疗农民疾病负担及医疗费用分析[J].华南预防医学.2008,34(5)：52-55.
[82]杨立雄,刘湘玲.对新型农村合作医疗基金几个问题的思考[J].湖南师范大学社会科学学报,2006,35(2)：12-17.
[83]阳秋林,唐建华,刘豪,等.刍论湖南省农村最低生活保障标准的确定[J].南华大学学报(社会科学版),2008,9(2)：40-42.
[84]徐润龙,叶真,曾国经,等.浙江省三县新型农村合作医疗方案对解决“因病致贫”问题的作用评价[J].中国卫生经济,2006,25(4)：36-37.
[85]毕兆荣,罗美芳,谈永奇.2006年住院病人医疗费用及影响因素分析[J].中国病案.2008,9(3)：18-19.
[86]施红英,沈毅,何凡.多水平模型在住院费用影响因素分析中的应用[J].2006,23(5)：397-399.
[87]苗丽琼,李江玲.住院病人系统疾病医疗费用的因子分析[J].中国医院统计,2006,13(3)：11-13.
[88]肖锦铖.合肥地区不同人群住院费用结构分析与期望调查[J].中国医院管理.2003,23(2)：17-20.
[89]何平平.我国医疗费用增长因素的计量分析[J].太平洋学报,2005,11：25-31.
[90]曹志辉,韩彩欣,张倩,等.沧州市住院患者医疗费用影响因素分析[J].中国医院管理.2007,27(2)：17-20.
[91]Nicolal JP.Budget caps and the quality of health care in Holland.Plast Reconstr Surg,1996,96(4):964-965.
[92]袁永林.军队卫生统计工作手册[M].北京：人民军医出版社,2002：64-66.
[93]候兆红,毕润芝.患者住院日与医疗费用比例的统计与分析[J].中国医院统计,2005,12(6)：167-168.
[94]马华.浅谈平均住院日[J].中国卫生统计,2005,22(4)：269.
[95]Holloway,RG,Witter,DM,Lawtan,KB.Inpatient costs of specific cerebrovascular events at five academic medical centers[J]. Neurology,1996,46 (3):854.
[96]于德志.健全医疗保障制度是解决看病难看病贵的重要途径[J].中华医药管理杂志,2006,22：73-76.
[97]李贝,毛宗福,李建平,等.湖北省居民住院费用影响因素分析[J].中国卫生事业管理,2005(8)：483-485.
[98]杨金侠.新型农村合作医疗农村定点医疗机构费用控制模型与实现机制研究[D].山东大学：2007.
[99]程念,付晓光,汪早立.2006年东部地区新型农村合作医疗运行情况分析[J].中国卫生经济,2008,27(8)：38-40.
[100]左延莉,胡善联,傅卫,等.2004年全国新型农村合作医疗资金使用情况分析[J].中华医院管理杂志,2006,22(11)：765-768.
[101]曹志辉,韩彩欣,张倩,等.沧州市住院患者医疗费用影响因素分析[J].中国医院管理,2007,27(2)：17-20.
[102]人民日报.中国新农合医疗：看病费用降低监管力度决定成败.http://www.fm120.com/content/2007-5/21/94029.html
[103]郝双英.影响农民参加新型农村合作医疗积极性的因素分析[J]卫生软科学,2006,20(2)：105-106.
[104]省合作医疗办.湖南省2007年新型农村合作医疗新增试点县市区培训教材-新型农村合作医疗实施方案设计.2007年9月.
[105]王芹萼.我国农村合作医疗制度运行机制研究[D].华中科技大学：2006
[106]孙标.新型农村合作医疗运行机制研究-以江阴市为例[D].南京师范大学：2008.
[107]陈虹,王新星.我国新型农村合作医疗运行机制研究[J].现代商贸工业,2009(13)：45-46.
[108]张磊,贺雪娇.剖析新型农村合作医疗制度的筹资意愿与能力[J].农村经济,2007,(5)：79-81.
[109]林存友.新农合基金运行中存在的问题及对策研究[J].中国乡镇企业,2009(1)：59-60
[110]吴燕、顾海.完善新型农村合作医疗管理运行机制的探讨[J].中国农村卫生事业管理,2007,27(11)：806-808.
[111]张英洁,李士雪.全国新型农村合作医疗试点运行状况分析[J].中国卫生事业管理,2008,(7)：481-482,491.
[112]韩俊、罗丹.中国农村卫生调查[M].上海：上海远东出版社,2007：1-522.
[113]湖南省新型农村合作医疗信息.湘潭市2007年1-9月份新型农村合作医疗基金运行情况分析报告.http://xt.hnhzyl.cn/show.asp?m_id=32&id=1893
[114]魏欣芝.新型农村合作医疗基金运行机制研究-以山东省为例[D].山东农业大学,2008.
[115]湖南省卫生厅.湖南省卫生厅关于印发《湖南省新型农村合作医疗基本药品目录(2010年版)》的通知.湘卫合医发[2010]1号.
[116]唐立健.新型农村合作医疗筹资水平和补偿方案的研究[D].东南大学：2006.
[117]唐松源,李迅,崔文龙,等.云南省弥渡县新型农村合作运行补偿机制研究[J].中国公共卫生,2006,22(3)：261-263.
[118]黄余送,杨善发.新型农村合作医疗基金管理模式探索[J],湖北社会科学,2007,(9)：60-62.
[119]左树岩,鞠秀荣.探索合作医疗制度下的大病补偿比[J].卫生经济研究,2001(13)：14-16.
[120]中国政府网.2009年湖南省农民人均纯收入实现连续六年增长.http:// www.china.com.cn/rollnews/2010-01/31/content 379412.htm
[121]仇雨临.医疗保险[M].中国人民大学出版社,2001.
[122]郑莹,李德绿,俞顺章,等.上海市恶性肿瘤疾病负担的研究[J].中国肿瘤,2001,10(4)：196-198.
[123]周守君,胡晓抒,钱颐等.南京市雨花台区肿瘤死亡疾病负担研究—疾病诊治需求与经济损失分析[J].中国卫生经济,2008,27(12)：52-55.
[124]陈启军,陈越,杜生明.论传染病的危害及我国的防治策略[J].中国基础科学,2005,7(6)：19-30.
[125]陈启军.论传染病的危害及我国的防治策略.中国人兽共患病学术研讨会论文集：13-19.
[126]湖南省卫生厅.关于《湖南省农村孕产妇住院分娩补助指导方案(试行)》的具体操作说明.湘卫合医函[2009]3号.2009年3月25日.
[127]王小合,严光府,曾国经等.浙江省新型农村合作医疗基金运行状况分析[J].中国初级卫生保健,2008,22(1)：27-31.
[128]Lynch WD. RO I Bullseye:demonstrating results with population health management[J].Absolute Advantage-The Workp lace Wellness Magazine, 2003,(2):20-50.
[129]陈君石,李明.个人健康管理在健康保险中的应用现状与发展趋势[J].中华全科医师杂志,2005,4(1)：30-32.
[130]杜乐勋,武广华,朱玉久,等.医院单病种付费概念与内容、历史和现状以及政策建议[J].中国医院管理,2007,27(9)：23-25.
[131]刘运国,傅卫,姚岚,等.论新型农村合作医疗制度中按病种付费制度的发展策略[J].中国医院管理,2007,27(8)：28-29.
[132]张歆,王禄生.按病种付费在我国新型农村合作医疗试点地区的应用[J].卫生经济研究,2007,2：20-21.
[133]李慧萍.湖南省新型农村合作医疗费用控制研究[D].国防科学技术大学：2007.
[1]景琳.农村合作医疗实用手册[M].四川：四川科技出版社,1998.6
[2]World Bank, World Development Report 1993:Investing in Health. (Washington, DC:World Bank,1993), P.111.
[3]Kenneth W. Newell. Health By The People. Geneva:World Health Orgnization,1975.
[4]World Health Organization. Primary Health Care[R]. Report of the International Conference on Primary Health Care. Geneva:WHO,1978.
[5]张自宽.让合作医疗遍地开花[N].健康报,1958年9月
[6]张自宽.积极推行集体保健医疗制度[N].健康报,1960年5月
[7]张自宽.如何巩固和办好合作医疗——黄岗地区合作医疗座谈会纪要[N].卫生部湖北农村卫生工作队简报(第1期),1966年6月.
[8]张自宽.农村合作医疗应该肯定应该提倡应该发展[J].农村卫生事业管理研究,1982,(2)：31-33
[9]世界银行.中国：卫生模式转变中的长远问题与对策[C].北京：中国财政经济出版社,1994.
[10]中国农村健康保险实验项目研究组.中国农村健康保险实验研究工作报告[J].中国卫生事业管理,1994,(2)：74
[11]系列研究课题组.农村合作医疗保健制度的系列研究.中国卫生经济,1988,7(4)：13-19.
[12]中国农村医疗保健制度研究课题组.中国农村医疗保健制度研究.上海：上海科学技术出版社,1991.
[13]张朝阳,杨辉,叶宜德.中国农村合作医疗改革技术总报告[J].中国农村卫生事业管理,1998,18(4)：11-20
[14]汪时东,叶宜德.农村合作医疗制度的回顾与发展研究[J].中国初级卫生 保健2004,18(4)：10-12.
[15]龚向光、胡善联、程晓明.贫困地区政府和集体在合作医疗筹资中的作用[J].中国卫生事业管理,1998,(10)：516-517
[16]顾杏元.中国贫困农村医疗保健制度社会干预试验研究.上海：上海医科大学出版社,1998.17
[17]张自宽.对合作医疗早期历史情况的回顾[J].中国卫生经济,1992,11(6)：21-23。
[18]李德成.中国农村传统合作医疗制度研究综述[J].华东理工大学学报(社会科学版),2007,(1)：19
[19]夏杏珍.农村合作医疗制度的历史考察[J].当代中国史研究,2003,10(5)：111
[20]曹普.改革开放前中国农村合作医疗制度[J].当代中国史研究.2007.(01)：142-143
[21]张自宽.关于我国农村合作医疗保健制度的回顾性研究[J].中国农村卫生事业管理.1994,14(6)：4-9
[22]张自宽.在合作医疗问题上应澄清思想统一认识[J].中国农村卫生事业管理,1992,(6)：8-10
[23]全国政协医药卫生体育委员会.关于农村卫生工作调查报告[J].中国卫生质量管理,1995,(3,4)：8
[24]顾涛,石俊仕,郑文贵,单杰.农村医疗保险制度相关问题分析及政策建议[J].中国卫生经济,1998,17(4)：42-43
[25]课题组.中国农村卫生服务筹资和农村医生报酬机制研究[J].中国初级卫生保健,2000(7)：3-10
[26]Shan Cretin, Albert P. Williams, Jeffrey Sine, "China Rural Health Insurance Experiment:Final Report, " RAND Health Working Papers, WR-411, August 2006.
[27]袁木,陈敏章.加快农村合作医疗保健制度的改革和建设[J].中国农村卫生事业管理,1994,14(9)：1-4.
[28]卫生部医政司.农村合作医疗出现了良好发展势头[J].中国农村卫生事业
管理,1997,(2)：13
[29]马振江.试论有中国特色的农村初级卫生保健体系[J].中国卫生经济,2000,(5)：51-52
[30]王延中.论新世纪中国农民医疗保障问题[J].战略与管理,2001,(3)：15-24
[31]聂妍,饶延华,周俊,冯聪,杜玉开.我国新型农村合作医疗制度的发展现状[J].中国社会医学杂志,2009,26(5)：263-264
[32]毛正中.规范和完善新型农村合作医疗制度[N].人民日报,2008-7-8
[33]刘军民.农村合作医疗存在的制度缺陷[J].华中师范大学学报(人文社会科学版),2006,45(2)：32-36
[34]乔益洁.中国农村合作医疗制度的历史变迁[J].青海社会科学,2004,(3)
[35]顾听,方黎明.自愿与强制性之间——中国农村合作医疗的制度嵌入性与可持续发展分析[J].社会科学研究,2004,(5)：1-18
[36]韩俊,罗丹.中国农村卫生调查[M].上海：上海远东出版社,2007.52-56.
[37]刘华,何军.中国农村医疗保障体系的经济学分析[J].农业经济问题,2006,(4)：14.
[38]胡鞍钢,胡琳琳.中国宏观经济与卫生健康[J].改革,2003,(2)：31.
[39]韩俊,罗丹.中国农村医疗卫生状况报告[J].中国发展观察,2005,1(1)：12-21
[40]张元红.农村公共卫生服务的供给与筹资[J].中国农村观察,2004,(5)：50-59
[41]World Health Organization. The World Health the Report 2000. Geneva: World Health Organization.
[42]Hossain S. I. Tackling Health Transition in China[R]. The World Bank, 1997,55.
[43]Bogg L. Health Care Financing in China:Equity in Transition [M]. Stockholm:Karolinska University Press, Division of International Health, Departmentof Public Health Sciences,2002:78-79.
[44]平新乔.从中国农民医疗保健支出行业看农村医疗保健机制的选择[J]. 管理世界,2003,(11)：34-36.
[45]朱玲.农村医疗救助项目的效果[J].经济学动态,2006,(8)：51.
[46]林闽钢.我国农村合作医疗制度治理结构的转型[J].农业经济问题,2006,(5)：24.
[47]侯剑平,邱长溶.健康公平理论研究综述[J].经济学动态,2006,(7)：44.
[48]湖南财政厅社会保障处调研课题组.湖南省新型农村合作医疗制度建设的调查报告.http://www.51Labour. com.2009-6-24
[49]Haltom C. Health risk management:well-being for the employee and the bottom line [J]. Benefits Q,2005,21(3):7-10.
[50]赵立飞.六种合作医疗筹资方法的比较[J].中国初级卫生保健,2006,20(8)：4-6.
[51]江启成,叶宜德,秦其荣,汪时东等。新型农村合作医疗农民个人筹资方式现况研究,中国卫生经济2006,25(12)：22-23
[52]刘雅静.对我国新型农村合作医疗筹资问题的几点探讨[J].华南农业大学学报(社会科学版),2007,(3)：10-14
[53]张磊,贺雪娇.剖析新型农村合作医疗制度的筹资意愿与能力[J].农村经济,2007,(5)：79-81
[54]王成艳,薛兴利.关于农村合作医疗筹资机制的探讨[J].卫生经济研究,2005,(1)
[55]胡善联.卫生经济学[M].上海：复旦大学出版社,2003.154
[56]轩志东.卫生经济改革理论研究与实践[M].北京：石油工业出版社,2001.243-246
[57]刘爱华.新形势下对农村卫生几个问题的看法[J].卫生工作通讯,1995,(3)：207
[58]王列军,葛延风.农村医疗保障制度建设需全面调整思路[N].中国经济时报,2005-06-07.
[59]杨金侠,江启成,王章泽,温丽娜.新型农村合作医疗医疗费用控制实证研究：不合理医疗费用控制模型与实施方略[J].中国卫生经济,2009,28(5)：14-16
[60]Links Beaty L. Understanding diagnostic related groups (DRGs) and inpatient hospital reimbursement [J]. Gastroenterol Nurs,2005,28 (5):363-371.
[61]Links Smith JJ, Maida A,Henderson JA. Hospital outpatient prospective payment under medicare:Understanding the system and its implications [J]. Radiology,2002,225(1):13-22.
[62]卫生部统计信息中心.第三次国家卫生服务调查分析报告[R].北京：中国协和医科大学出版社,2004.
[63]左延莉,胡善联,傅卫,江芹.全国新型农村合作医疗试点现况研究[J].中国卫生资源,2006,9(3)：127-129.
[64]吴之寿.谈对医疗保险定点医院的监督管理[J].中华医院管理杂志,2001,17：281-282.
[65]苏红.医疗费用控制及相关问题研究[J].国际医药卫生导报,2005,(07)
[66]王龙兴.上海市医疗保险制度改革的实践[J].中华医院管理杂志,2000,16(5)：280-282.
[67]王靖元.新农合滚动筹资理论与实践[M].北京：北京大学医学出版社,2006.
[68]胡善联,左延莉.中国农村新型合作医疗制度的建立：成绩和挑战[J].卫生经济研究,2007,11：3-6.
[69]王兰芳,孟令杰,徐芳.新型农村合作医疗对农民影响的实证研究——以江苏的调查为例[J].农业经济问题2007,(7)：22.
[70]萧庆伦,汪宏,王禄生,高建民,张里程,薛秦香.中国农村互助医疗[J].中国卫生经济,2004,23(7)：5-8
[71]刘远立,任苒,陈迎春,胡善联,萧庆伦.中国农村贫困地区合作医疗运行的主要影响因素分析——10个县干预试验结果[J].中国卫生经济,2002,21(2)：11-16
[72]毛正中,蒋家林.如何合理制定“新农合”方案[EB/01].http: //www. cncms. org. cn/,2005-5-17.
[73]胡毅烈.新农合基金要最大限度用于农民[EB/01].http: //www. cncms. org. cn/,2005-10-8.
[74]汪长如,叶宜德.新型农村合作医疗管理模式与经办机构研究[J].中国农村卫生事业管理.2007,27(7)：491
[75]董烈军.完善新型农村合作医疗制度的思考[J].安徽农业大学学报,2006,15(7)：22-25
[76]叶宜德,张朝阳,胡善联,罗珏,汪和平.新时期农村合作医疗保障制度的基本模.http://www. cncms. org. cn/Content. asp?ID=1110&LClass_ID= 62.2004-7-9
[77]李华.新型农村合作医疗制度的制约因素与发展对策[J].求实杂志,2005,(10)：40-41.
[78]王禄生,应亚珍.新型农村合作医疗基金运行风险防范对策[J].中国卫生经济,2006,25(11)：36-38.
[79]杨金侠,李士雪.对新型农村合作医疗定点医疗机构监管的途径与程序[J].中国卫生经济,2006,25(2)：25-26.
[80]周伟,王靖元,徐德斌.新型农村合作医疗支撑要素分析[J].中国农村卫生事业管理,2005,25(11)：14-15.
[81]Ashworth M, Lea R. How are primary care organizations using financial incentives to influence prescribing [J]. J Public Health, 2004,26(1):48-51.