新型农村合作医疗与城镇居民基本医疗保险对象医疗服务利用及费用情况的比较分析

摘要

Objective: To compare the health care utilization and medical expense of new rural cooperative medical system ( NCMS) with Basic Medical Insurance for Urban Residents ( BMIUR) , after the implementation of capitation reform. Methods: It study collected the operating data of NCMS and BMIUR, including financing, operation and compensation, and interview data of related managers. Results: Compared with BMIUR, there is a significant effect of controlling the growth of participating farmers’ medical expense after capitation reform. Conclusion: Compared with BMIUR, the participating farmers are obviously aging, so the fund of NCMS will face more compensation expenses, according to the limited fund, it is very urgent to control the growth of medical expense.%目的：比较分析浦东新区新型农村合作医疗“按人头支付”改革之后，参合对象与区域内城镇居民基本医疗保险对象的医疗服务利用和费用情况的差异。方法：收集新型农村合作医疗及城镇居民基本医疗保险运行数据，包括筹资、运行和参保人群受益状况等的数据资料，以及相关管理人员的定性访谈资料。结果：与城镇居民基本医疗保险相比，“按人头支付”改革对于控制参合农民医疗费用的增长具有明显效果。结论：与城镇居民基本医疗保险相比，新型农村合作医疗参合对象明显老龄化，新型农村合作医疗统筹基金将面临更多的补偿支出，因此在基金总额有限的情况，对于控制医疗费用增长的要求会更为迫切。