目的:总结蓝山和桑植两县新农合支付方式改革的新经验、新方法,为进一步深化改革提供经验和理论支持。方法:运用普查和抽样调查方法,对两县推行新农合支付方式改革的总体情况进行调查,并对部分乡镇卫生院及其医务人员、患者进行问卷调查和深入访谈。结果:两县推行限额付费方式,当年新农合基金风险可控,医、患满意度高。结论:明确医疗服务的享受主体、服务主体及范围,科学制定总额预付标准,完善改革以有效规避医患道德风险,建立医疗服务与社会医疗保险二位一体的新体制等。 OBJECTIVE: To summarize the new experiences and new methods in the reform of new rural cooperative medical system in Lanshan and Sangzhi counties, and to provide empirical and theoretical support for further deepening the reform. Methods: By means of census and sample survey, the general situation of the reform of the new rural cooperative medical system in two counties was investigated. Questionnaires and in-depth interviews were conducted with some township hospitals, their medical personnel and patients. Results: In the two counties, the limit payment method was adopted. In the same year, the risk of NCMS was controllable, and the satisfaction of doctors and patients was high. Conclusion: It is necessary to clarify the subjects, service providers and scopes of medical services, formulate the standard of total prepayment, improve the reform so as to effectively avoid the moral hazard of doctors and patients, and establish a new system of medical services and social medical insurance.