西南石油大学学报(社会科学版) ›› 2011, Vol. 4 ›› Issue (2): 75-79.DOI: 10.3863/j.issn.1674-5094.2011.02.015

• 经济学与管理学 • 上一篇    下一篇

新农合补偿方案的三大关键要素

李斌1a 李鎏勋1b 徐影涛2   

  1. 1.中南大学:a. 社会学系,b.湘雅医学院,湖南 长沙 410083; 2.川庆钻探工程有限公司地球物理勘探公司信息中心,四川 成都 610213
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2011-03-20

THREE MAJOR FACTORS IN THE REIMBURSEMENT SCHEME OF THE NEW RURAL COOPERATIVE MEDICAL CARE SYSTEM

LI Bin-1a LI Liu-xun1b XU Ying-tao2   

  1. 1.Central South University: a.Department of Sociology;b.Xiangya School of Medicine,Changsha Hunan,410083,China;2.Information Center,Geophysical Exploration Company,Chuanqing Drilling Engineering Co. Ltd.,Chengdu Sichuan 610213,China
  • Received:1900-01-01 Revised:1900-01-01 Online:2011-03-20

摘要: 新农合制度是我国新农村建设中的一个重要组成部分,科学合理的补偿制度是新农合制度健康发展的根本,围绕主要影响补偿制度的三大基本参数:补偿比、起付线和封顶线进行分析,讨论了这一补偿制度存在的问题,指出:目前全国各地均将新农合补偿的重心放在乡镇卫生院,即参合农民在乡镇卫生院所发生的医疗费用有较高的补偿比、较低的起付线和较高的封顶线,这样的补偿设计在方便农民就医的同时,与缓解大病致贫的目标有相悖之处。并对此提出了对策建议,认为:应该通过差异性较大的起付线分流患者,不同级别医院大体一致的补偿比确保新农合制度的公正性,通过年度封顶线和单病种封顶线相结合的方式确保基金的安全。

关键词: 新型农村合作医疗制度, 补偿制度, 补偿比, 起付线, 封顶线

Abstract: A scientific and reasonable reimbursement scheme is the premise of healthy development of new rural cooperative medical care system.This paper analyzes problems in the present reimbursement scheme in terms of the three major influencing factors: reimbursement ratio,deductible,and upper limit of reimbursement.The findings reveal that the insured rural residents now get better reimbursed when hospitalized locally.This offers them great convenience but at the same time fails to keep them from being impoverished by serious diseases.Based on the above findings,the authors suggest a differentiated deductible amount to distribute patients,a similar reimbursement ratio to guarantee a fair new rural cooperative medical care system,and a combination of yearly upper limit and disease upper limit to ensure fund security.

Key words: new rural cooperative medical care system, reimbursement scheme, reimbursement ratio, deductible, upper limit

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