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目的:探索适合宁夏不同经济水平地区的新型农村合作医疗的起付线、封顶线及补偿比的测算。方法:从宁夏4个地(市)中,根据经济发展水平与地理位置分别选择川区的平罗县与山区的隆德县作为试点县,按照设计方案具体实施。从抽取的住院病人的住院总费用,按95.00%以上的住院病人可得补偿为原则设计起付点,即按百分位数法第5百分位数为起付线、第95百分位数住院病人的平均费用的2倍为最高限额为封顶线。结果:川区平罗县的起付线分别为250.00元、200.00元,封顶线为19331.00元,县、乡级补偿比分别为50.00%、55.00%;山区隆德县的起付线分别为140.00、90.00元,封顶线为3283.00元,县、乡级补偿比分别为60.00%、65.00%。结论:宁夏不同经济水平地区的起付线、封顶线及补偿比应不同,不同经济水平地区实行不同分段按比例补偿比。
Objective: To explore the calculation of the payoff line, capping line and compensation ratio for the new rural cooperative medical system in different economic levels in Ningxia. Methods: From 4 prefectures (cities) in Ningxia, according to the level of economic development and geographical location, Pingluo County in Sichuan Province and Longde County in the mountainous region were selected as pilot counties and implemented in accordance with the design scheme. From the total hospital cost of inpatients drawn, the starting point should be designed based on the principle that 95.00% of the inpatients can obtain compensation, that is, the 5th percentile according to the percentile method is the starting line and the 95th percentile. The maximum of 2 times the average cost of inpatients is the ceiling line. Results: The payoff lines in Pingluo County of Sichuan Province were 250.00 yuan and 200.00 yuan respectively, the ceiling line was 19331.00 yuan, the compensation ratios at the county and township levels were 50.00% and 55.00%, respectively; the payoff lines at the mountainous districts in Longde County were 140.00 yuan respectively. , 90.00 yuan, capped line is 3283.00 yuan, county, township level compensation ratio were 60.00%, 65.00%. Conclusion: The payoff line, capping line and compensation ratio in different economic level areas of Ningxia should be different. Different economic level areas should implement different segmented prorated compensation ratios.