陕西省新型农村合作医疗费用负担和补偿情况分析.docx

陕西省新型农村合作医疗费用负担和补偿情况分析*王文杰①，李琛①，罗密①，彭宏宇①，孙杨，冯友梅①，崔丹①，毛宗福①*基金项目：国家自然科学基金项目。①武汉大学健康学院 武汉 430071②武汉大学政治与公共管理学院 武汉 430072作者简介：王文杰（1992—），男，硕士研究生；研究方向：卫生事业管理；电话E-mail：2016203050023@。通讯作者：毛宗福；E-mail：zfmao@126.com。摘 要 目的：调查了解陕西省新农合基金运行数据，分析其新农合的费用负担和补偿受益情况，为医疗保险政策完善提供参考。方法：分层抽样法抽取陕西省41个县，调查数据来源于样本县的新农合填报数据，数据整理后采用SPSS统计描述分析。结果：随着新农合政策的推进，陕西省新农合的参合与筹资水平逐年提高，参合率在2009年及以后达到95%以上；新农合保障水平不断提升，参合农民的医疗卫生服务可及性明显提高；报销比重稳步提升，平均保持在50%，但次均住院费用快速增加，加上不合理的住院人次和基金的流向，削弱了参合农民补偿受益。结论：经过多年的建设和改革，陕西省新农合的运行取得了明显成效，新农合覆盖范围不断扩大，保障水平逐渐提高，总体来看新农合对农民的疾病经济负担有所减轻，但新农合的住院医疗服务利用结构不合理，报销水平仍需进一步提高，医保支付方式改革还需进一步推进。关键词 新农合；疾病负担；补偿受益；陕西Analysis on the Burden and Compensation of New Rural Cooperative Medical Scheme in Shaanxi ProvinceAbstract Objective: To investigate the operation data of the New Rural Cooperative Medical Scheme (NCMS) fund in Shaanxi province, analyze the cost burden and compensation benefits of the NCMS in order to provide reference for further improving the medical insurance policy. Methods: Using the stratified sampling method to select 41 counties in Shaanxi province. The data were collected from NCMS operational data of the sample county, and SPSS was used for statistical and descriptive analysis. Results: With the advancement of the NCMS, the level of the participation rate and funding of NCMS in Shaanxi province has steadily increased year by year, and the participation rate has reached over 95% in 2009. The protect level of NCMS has been continuously improved, and significant increase in access to health care services of the participating farmers. The proportion of reimbursement increased steadily and remained at an average of 50%. However, the average hospitalization cost increased rapidly, coupled with unreasonable hospitalizations and the flow of funds, which weakened the benefits of participating farmers compensation. Conclusions: After years of construction and reform, the operation of NCMS in Shaanxi province has achieved obvious results. The