【摘要】 目的总结2014年、2015年新型农村合作医疗运行情况,以期达到资金的筹措稳定和收支平衡。方法回顾分析2014年、2015年荆州市新型农村合作医疗在全面落实22种重大疾病保障水平和门诊重症工作,扩大重大疾病和门诊特殊病种补偿范围的同时,加强对不合理的医疗费用审核的运行效果。结果荆州市新型农村合作医疗门诊补偿受益面达到250%以上,住院补偿受益面达到14%以上。重大疾病住院人数主要集中在县级医院,赔付费用主要集中在外地医疗机构,相同病种的赔付金额外地医疗机构显著高于本地医疗机构。结论切实实施分级诊疗,建立完善的举报和投诉制度,加大对新农合基金的稽查力度,有效地使基金的结余率控制在一定的水平,防止基金透支。引入商业保险机制,进一步改善医疗机构的服务,以质优便捷的医疗服务提高新农合自身的公信力。更多还原

【Abstract】 Objective:To summarize 2014-2015 new rural cooperative medical system operation and ensure stable fund collection and balance.Method:The authors made the retrospective analysis on2014-2015 new rural cooperative medical system in the over-all guarantee of 22 serious diseases and outpatient severe cases,enlargement of compensation for serious diseases and special diseases,and the reinforcement of unreasonable medical expense audit in Jingzhou City.Result:Outpatient scope of benefits under new rural cooperative medical system in Jingzhou City is above 250% and hospitalization scope of benefits is above 14%.Patients with severe diseases concentrate in county-level hospitals,while compensation fees are in foreign medical institutions.Compensation for the same disease is remarkably higher in foreign medical institutions than local ones.Conclusion:We should practice classified diagnosis and treatment,establish perfect system for report and complaint,enhance the inspection for new rural cooperative medical system,constrain effectively fund balance rate at a certain level,prevent fund overdraw,introduce commercial insurance mechanism,and further improve the service in medical institutions and the credibility of new rural cooperative medical system with the service of high quality and convenience.更多还原