我国新型农村合作医疗制度运行效果分析

代涛; 朱坤; 张小娟

引用本文：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

我国新型农村合作医疗制度运行效果分析

投稿时间：2013-04-20 修订日期：2013-06-08 PDF全文浏览 HTML全文浏览

中国医学科学院医学信息研究所/卫生政策与管理研究中心

摘要:目的：分析新医改三年来我国新农合制度的运行效果，为进一步完善新农合制度提供依据。方法：选择北京、安徽、河南和陕西作为样本省市，抽取四省市2008—2011年的新农合报表数据，以2008年的数据作为基数，采用前后对比的方法分析四省市新农合运行情况。结果：新农合的人群覆盖率逐年提高, 2011年四省市的参合率均在96%以上；保障范围不断扩大；补偿水平逐年提升，2011年住院实际补偿比在45%以上，但参合农民个人医疗卫生支出未见明显减轻。新农合基金筹集和支出水平增长速度较快，收支趋于平衡；经办管理资源不足，监管仍需加强；新农合异地结算和即时结报取得进展，但新农合制度与其他医疗保险制度之间的转移接续问题有待解决。结论：医改三年新农合制度建设和运行取得明显成效，覆盖的广度、宽度和深度均有所改善；参合农民的卫生服务可及性明显提高，新农合自身的制度建设取得显著进展；但新农合仍面临挑战，可持续的筹资增长机制尚未建立，支付方式改革亟需突破，经办能力和管理水平仍有待进一步提高，新农合制度与其他医保制度的转移接续问题有待解决。建议：抓紧落实稳定的新农合筹资增长机制；加强新农合管理体系建设，提高基金监管能力；控制医药费用过快上涨，减轻参合农民疾病负担；探索新农合与其他医疗保险制度之间的转移接续机制。

关键词:新型农村合作医疗全民覆盖效果评价

基金项目:中澳卫生与艾滋病项目“医药卫生体制改革评价研究”

Analysis of the operational effect of New Rural Cooperative Medical Scheme in China

Abstract:Objective: To analyze the operational effect of the New Rural Cooperative Medical Scheme (NRCMS) since the health reform started three years ago, in order to provide recommendations for further improving the NRCMS. Methods: Beijing, Anhui, Henan and Shaanxi provinces were selected as sample areas, and NRCMS operational data between 2008 and 2011 was collected and analyzed with descriptive and comparative analysis. Data of 2008 was taken as the base period. Results: The coverage rate for the NRCMS has increased yearly, with participation rates of 2011 in the four areas reaching above 96%. Coverage has continued to expand, and compensation levels are increasing annually. The hospital stay compensation rate in 2011 was over 45%. However, the medical cost burden on rural residents is not reducing significantly. The NRCMS saw relatively rapid growth in funding pools and payment levels, with the trend toward equilibrium between costs and compensation continuing. Management resources are lacking, and the supervision capability is weak. There has been progress made in the long distance transaction and timely reimbursement on the spot, but there is still work to be done in the transfer among different health insurances. Conclusions: Over the past three years, marked progress has been made, with NRCMS coverage improvements having been made in terms of breadth, width, and depth of service. Access to health services has markedly improved, with clear progress in the NRCMS institutionalization. The NRCMS, however, still faces challenges, with a sustainable fund growth mechanism yet to be established and a reform to payment methods still needed. Management ability is still lacking, with work yet to be done in the transfer among different health insurances. Recommendations: Implementation of a stable NRCMS fund growth mechanism. Strengthening of the NRCMS management system. Increasing fund supervision capabilities. Controlling of rapid medical cost increases. Reduction of the burden on patients participating in the NRCMS. Exploring possibilities regarding the transfer among different health insurances.

Key words:New Rural Cooperative Medical Scheme Universal health coverage Effect Evaluation

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