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目的:评价新型农村合作医疗实施“按人头支付”改革对参合农民门诊医疗费用控制的效果。方法:收集浦东新区“按人头支付”改革实施前、后的新型农村合作医疗运行数据以及35万参合农民2011—2012年1 160万门诊人次的就诊费用、补偿金额等数据并进行比较分析。结果:新型农村合作医疗支付方式改革后,对于控制门诊医疗费用的过快增长有明显作用,进而有利于确保新型农村合作医疗基金收支平衡。结论:目前,按人头支付改革仅使得社区卫生服务机构初步形成自我约束机制,如何激励二、三级医院医务人员主动控费,制定配套政策有待深入研究。
Objective: To evaluate the effect of new Rural Cooperative Medical System (CMS) implementation on the control of farmer outpatient medical expenses in the reform of participating farmers. Methods: The data of new rural cooperative medical operation before and after the implementation of reform and “post-pay” policy in Pudong New Area, as well as the consulting fees and compensation amounts of 11 million outpatients from 350,000 participating peasants in 2011-2012 were collected and compared . Results: After the reform of the payment method of new rural cooperative medical system, it has a significant effect on controlling excessive growth of out-patient medical expenses, which in turn helps to ensure the balance of payments of the new-type rural cooperative medical fund. Conclusion: At present, the reform of head-to-head payment only makes the community health service agencies initially form a self-restraint mechanism. How to inspire the medical staffs in secondary and tertiary hospitals to take the initiative to charge fees and formulate supporting policies needs further study.