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目的:对新型农村合作医疗按人头支付政策干预的实证效果进行评价。方法:收集2011—2015年浦东新区按人头支付干预前后新型农村合作医疗相关数据指标,评价政策干预对基金运行、就诊行为和补偿状况等的总体影响。结果:基金筹资水平不断提高,2015年人均筹资标准已达到2 000元/人;基金运行风险得到控制,2015年当年基金结余率达到8.84%;参合对象医疗服务需求逐年释放,2015年参合对象的年人均门诊就诊次数达到20次,年住院率为10%;医疗费用迅速增长的态势得到遏制,尤其次均住院费用增幅下降明显;2015年参合对象门诊和住院医疗费用的实际补偿比分别为60%和55%。结论:按人头支付政策实施3年多来,在费用控制方面取得了较好的效果。但在城乡基本医疗保险一体化管理的背景下,参合对象医疗费用的实际补偿比有待进一步提高。
OBJECTIVE: To evaluate the demonstration effect of the new-type rural cooperative medical system on the policy of human-based payment policy. Methods: To collect the data of new rural cooperative medical system before and after intervention in Pudong New Area from 2011 to 2015, and to evaluate the overall impact of policy intervention on fund operation, medical treatment and compensation status. Results: The fund raising level was continuously raised. The per capita funding level in 2015 reached 2,000 yuan / person. The fund’s operational risk was controlled. In 2015, the fund balance rate reached 8.84%. The demand of participating medical service was released year by year, The number of outpatient visits per capita reached 20 and the annual hospitalization rate was 10%. The rapid growth of medical expenses was checked, especially in the decrease of average hospitalization expenses. The actual compensation rates for outpatient visits and hospitalization expenses in 2015 were 60 % And 55%. Conclusion: According to the policy of payment of head for more than three years, the cost control has achieved good results. However, in the context of the integrated management of urban and rural basic medical insurance, the actual compensation ratio of the medical expenses of the target partners needs to be further improved.