管理评论

管理评论 ›› 2020, Vol. 32 ›› Issue (10): 22-33.

• 经济与金融管理 • 上一篇    下一篇

新型农村合作医疗实际住院补偿比影响因素分析

张顺明, 纪晨, 王海潮   

  1. 中国人民大学财政金融学院, 北京 100872
  • 收稿日期:2017-08-14 出版日期:2020-10-28 发布日期:2020-11-07
  • 通讯作者: 张顺明(通讯作者),中国人民大学财政金融学院教授,博士生导师,博士
  • 作者简介:纪晨,中国人民大学财政金融学院博士研究生;王海潮,中国人民大学财政金融学院本科生。
  • 基金资助:
    国家自然科学基金面上项目（71573220；71773123）。

Determinants of the Actual Inpatient Reimbursement Rate under the New Rural Cooperative Medical Scheme

Zhang Shunming, Ji Chen, Wang Haichao   

  1. School of Finance, Renmin University of China, Beijing 100872
  • Received:2017-08-14 Online:2020-10-28 Published:2020-11-07

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摘要： 本文使用安徽省淮南市卫生局2010—2014年五期数据，对新农合实际住院补偿比的影响因素进行了考察，同时对影响因素中的不同等级医疗机构的选择进行进一步分析。结果表明，年度效应、就诊医院等级、人口属性是影响新农合实际住院补偿比的主要因素。具体来讲，2010—2013年间实际住院补偿比例逐年递增，并随就诊医院等级升高而显著降低，五保户、低保户、残疾人口等特困群体的实际补偿比显著高于普通农业人口。在影响就诊医院等级的因素中，报销者年龄、性别和患病程度指标有显著影响，不同属性人口对医疗机构选择基本没有偏好，但是五保户人口除外。据此本文推断，以实际住院补偿比例衡量，新农合补偿程度逐年改善，并在一定程度上起到了引导农民就医流向的作用，对残疾贫困等人群的优惠照顾达到了实际效果，但患者对城市各等级医院需求过大，医疗资源分配不均情况仍然存在，需要得到进一步改善。

关键词: 新型农村合作医疗, 实际住院补偿比, 人口属性, 医疗机构选择

Abstract: Using the data of 2010 to 2014 from Huainan Municipal Health Bureau, we investigate the factors that affect the actual inpatient reimbursement rate under the New Rural Cooperative Medical Scheme (NRCMS), and further analyze the factors affecting the choice of different levels of medical institutions. The result shows that factors affecting the NRCMS actual inpatient reimbursement rates are mainly years, hospital levels, population attributes. Specifically, the actual reimbursement rate increases with time and decreases with higher level facilities. Besides, the rate of lower income population and disabled people is higher than ordinary agricultural residents. In terms of medical facility choice, age, gender and disease degree have significant influences. While population of different attributes does not show obvious preferences except for househo lds enjoying five guarantees. Accordingly, this paper concludes that the NRCMS plays a reasonable role, measured by hospital compensation ratio, in guiding the choices of the medical institution and taking care of the poor and other disadvantaged groups. However, the needs of the patients are too large in all grade hospitals in the city and the uneven distribution of medical resources still persists, which needs to be further improved.

Key words: NRCMS, actual inpatient reimbursement rate, population attributes, medical facility choice