| 引用本文: |
何丽月,潘文利,林颖,等.海南省新型农村合作医疗参合农民乡镇住院“限费医疗”效果评价[J].中国卫生经济,2017,(8):36-40.[点击复制] |
.Impacts of the payment policy fix out of pocket for NRCMS patients in rural Hainan, China[J].CHINESE HEALTH ECONOMICS,2017,(8):36-40.[点击复制] |
|
| 摘要: |
| 目的：评价新农合参合农民乡镇住院“限费医疗”政策对住院利用、就诊流向、患者经济负担及农合资金分配的影响，为完善相关政策提供依据。方法：数据主要来源于新农合报表、医院统计报表和住院病历等资料，评价指标主要选取住院人次、次均住院费用、次均自付费用、农合资金分配比等。分析方法主要采用描述性分析和倍差法模型，并结合访谈资料对定量研究结果进行补充和解释。结果：该政策可能增加乡镇卫生院的住院人次数，对促进患者留在乡镇卫生院的作用有限；乡镇卫生院全病种次均住院费用和自付费用均下降；实施了限费医疗政策的万宁市高血压、肺炎的次均住院费用均无明显变化，而次均自付费用分别上升了11%和28%；对农合资金分配无显著影响。结论：该政策对控制医疗总费用有积极作用，但对患者合理分流和农合资金分配作用有限。对病人住院经济负担的影响因病种而异，小病可能会增加自付费用。 |
| 关键词: |
| DOI： |
|
| 基金项目: |
|
| Impacts of the payment policy fix out of pocket for NRCMS patients in rural Hainan, China |
|
| () |
| Abstract: |
| Objective：This study aimed to evaluate the impacts of the “ fix out of pocket” payment policy on inpatients visits and medical expense s per visit for New Rural Cooperative Medical System(NRCMS) and to examine whether the medical insurance payment change could really solve the problem of difficulties and high costs of receiving medical services or not in rural Hainan, China; Methods: Using descriptive analysis, difference in difference (DID) model based on data from Wanning county where the new policy has been carried out, Ledong county where has not, including claim data, medical records and hospital utilization data from Nov 2010 to Oct 2014. We also supplemented and interpreted the results of quantitative analysis combined with qualitative data from the interview recording material; Results: The policy may increase the number of inpatient visits, but had limited effect on keeping patients in primary medical institutions. The policy reduced the average medical expenses per inpatient visit at township hospitals on the whole . As for the two most common hospitalized diseases(hypertension and pneumonia), from DID model, the policy increased out of pocket(OOP) in Wanning by 11% and 28% respectively. As for the allocation of NRCMS fund, there is no significant influence; Conclusion: The “fix out of pocket” policy can reduce the hospitalization cost per visit at township hospital on the whole, but may neither increase the utilization of inpatient services nor rationalize the use of NRCMS fund. The impacts for patients’ payment differ in different areas. For mild cases, it may increase OOP and length of stay |
| Key words: |
