引用本文:于保荣, 张小娟.商业保险公司参与经办新农合的效果分析[J].中国卫生政策研究,2018,11(8):63-68 |
|
商业保险公司参与经办新农合的效果分析 |
投稿时间:2017-10-11 修订日期:2018-05-09 PDF全文浏览 HTML全文浏览 |
于保荣1, 张小娟2 |
1. 对外经济贸易大学保险学院 北京 100029; 2. 中国医学科学院医学信息研究所 北京 100020 |
摘要:目的:为商业保险公司经办新农合对经办成本、基金和患者的管理等产生的影响提供证据。方法:收集了商业保险公司参与经办新农合(商保模式)最广泛的两省所有区县2009—2012年新农合报表数据;现场收集了部分县新农合运行的全部费用及全部经办人员信息。商保模式与政府经办的县按照1:2进行匹配,逐年对比经办数据。结果:商保模式的经办费用更高、经办人员更多。商保模式的筹资比例更高、补偿比例更低、住院率更高、基金结余更多。患者和医保基金流向城市医院的情况,两省表现出相反的结果。讨论:(1)商保模式下,政府依然会设置新农合管理办公室,也就需要一定的人员和经费,因而该模式的经办成本更高。从侧面反映了新农合经办人力和经费的不足。(2)商保模式下,筹资水平高、住院实际补偿比例低、基金结余高,可能反映了商业保险公司的管理工作更细致到位,但这仅仅是一种可能的解释。(3)两省患者县外就医比例和资金流向呈现不同结果,可能反映了不同保险公司经办能力的差异。(4)商业保险公司参与新农合经办的程度有限,无法有效激励其行为。 |
关键词:新型农村合作医疗制度 商业保险公司 经办成本 效果 |
基金项目:国家自然科学基金面上项目(71173135/G0308);美国中华医学基金会“卫生政策与体系科学青年学者国内培训与研究资助项目”(CMB09-991);对外经济贸易大学学科建设专项项目(XK2014123);对外经济贸易大学社会保障学特色学科项目(8110051103) |
|
An analysis on the effects of commercial insurance companies participating in the management of the New Rural Cooperative Medical Scheme |
YU Bao-rong1, ZHANG Xiao-juan2 |
1. School of Insurance and Economics, University of International Business and Economics, Beijing 100029, China; 2. The Institute of Medical Information, Chinese Academy of Medical Science, Beijing 100020, China |
Abstract:Objective:With the support of government policies, the Chinese Commercial health insurance companies have participated in operation business of the New Rural Cooperative Medical Scheme(NRCMS) with different degrees of participation through the Commercial Insurance Model (CIM). Whether the commercial insurance companies handle the NRCMS will haveaninfluence on the operational cost, fund and patient management, evidences are needed.Methods:NRCMS management data of 2009-2012 were collected in all districts and counties of the two provinces where CIM are the most popular. The entire fees of NRCMS operation were collected through field visit in selected counties. The Commercial Insurance Model is matched with the Government handling county according to the ration of 1:2 (Matching 1 CIM county with 2 government handling counties), and from the operational information, data was processed year by year. Results:Compared with government handling counties, CIM counties spend more fiscal expenditure and more staff in NRCMS operation, and with higher fundraising ratio, lower compensation rate, higher hospitalization rate and more fund surplus too. According to the situation in which patients and health care funds flowed to urban hospitals, different results were found in the two provinces.Discussion:1) Even under CIM, the government still sets NRCMS management office, which requires a certain amount of personnel and funds, which causes higher operational cost for CIM. This reflected the shortage in manpower and expenditure for NRCMS operation.2) The higher level of fundraising, lower hospitalization compensation ratio and more fund surplus for CIM may reflect better management skills for commercial insurance companies, but this is only one possible interpretation. 3) Different trends were discovered for patients flowing to urban hospitals and related insurance fund distribution in two provinces, which may reflect differences in ability of business operation among commercial insurance companies. 4) Under CIM, the degree at which commercial insurance companies participate in NRCMS is very limited, which could not effectively motivate their behavior.There is only one insurance company that was selected to play in a county, and essentially did not introduce competition mechanism, which deviates from the core idea of new public management theory. |
Key words:New rural cooperative medical Scheme (NRCMS) Commercial insurance company Operational cost Effect |
摘要点击次数: 1217 全文下载次数: 962 |
|
|
|
|
|