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目的:分析湖北省所有64个农村县级行政区划新农合和医保基金的总体运行情况,为湖北省医疗保险政策完善提供参考。方法:资料来源于湖北省各级卫计委、人社、医疗机构填报的表格;将各县域依照经济发展水平分为三类,分析筹资水平,支出、结余情况,患者就医流向,补偿水平。结果:湖北省县域新农合、城镇职工与居民医保参合人数稳定;筹资总额、累积结余呈增长趋势;县域外就诊比例保持平稳,三类地区略高;住院实际补偿比和经济发展状况呈正相关。结论:湖北省县域内三项基金总体运行状况良好,城镇医保基金运行状况优于新农合基金;各项基金的筹资水平增长迅速,然而实际补偿比未见明显提高。
OBJECTIVE: To analyze the overall operation of NCMS and Medicare funds in all 64 rural county administrative divisions in Hubei Province, and provide reference for the improvement of medical insurance policy in Hubei Province. Methods: The data were obtained from the forms reported by the health planning commissions, people’s associations and medical institutions at all levels in Hubei Province. The counties were divided into three categories according to the level of economic development. The funding levels, expenditures and balances, the patient flow and the level of compensation were analyzed. Results: The number of new rural cooperative medical workers, urban workers and residents in Hubei Province was stable. The total amount of fund-raising and cumulative balance showed an increasing trend. The proportion of out-of-county medical treatment remained stable and slightly higher in the three categories. The actual hospitalization compensation ratio was positively correlated with the economic development . CONCLUSION: The three funds in Hubei province are in good overall running condition. The urban medical insurance fund is better than the new rural cooperative fund. The fund raising rate of each fund has been increasing rapidly. However, the actual compensation ratio has not significantly increased.