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该文调查分析某省3个试点县合作医疗补偿机制和大病补偿情况,采用集中曲线和Pen氏分析方法,发现门诊和住院病人收入越高补偿额越高,存在“穷帮富”不公平现象;县内与县外病人相比,县外病人虽然发生例数少,但补偿额大,耗费合作医疗基金。建议根据收入水平,设计不同的筹资和补偿方案,体现公平;做好病人转诊管理,控制县外病人,提高县外病人补偿起付线。
This paper investigates and analyzes the compensation mechanisms and the compensation for serious illness in 3 pilot counties in a province. Using the concentration curve and Pen’s analysis, it finds that the higher the outpatient and inpatient income, the higher the compensation, and the existence of “poor to help the rich” Fair phenomenon; compared with patients outside the county outside the county, although the number of cases outside the county less, but the compensation amount is large, the cost of cooperative medical funds. According to the income level, it is suggested to design different fund-raising and compensation programs to show fairness; to do patient referral management, control patients outside the county, and increase compensation for patients outside the county.