CAJ | 학술논문

目的：探索黑龙江省新型农村合作医疗门诊医保支付效果及存在问题。方法：针对60个地区合管办负责人的问卷调查结果，通过探索性因子分析得出门诊支付效果和存在问题的分类；采用t检验对分类后各项目得分进行比较；采用秩和检验对不同地区医保支付效果和存在问题得分比较。结果：支付效果分为服务质量和费用控制效果，存在问题分为经办机构和医疗机构存在的问题，并且其得分差异（P<0.05），均具有统计学意义。不同地区的农民年均收入各项得分、不同支付方式地区的各项得分比较（P<0.05），具有统计学意义。结论：有效加强医保支付的费用控制，提高农民实际受益水平；改善经办机构条件，加快医保支付方式改革；充分调动定点医疗机构的积极性，提高医院服务质量。
목적：탐색흑룡강성신형농촌합작의료문진의보지부효과급존재문제。방법：침대60개지구합관판부책인적문권조사결과，통과탐색성인자분석득출문진지부효과화존재문제적분류；채용t검험대분류후각항목득분진행비교；채용질화검험대불동지구의보지부효과화존재문제득분비교。결과：지부효과분위복무질량화비용공제효과，존재문제분위경판궤구화의료궤구존재적문제，병차기득분차이（P<0.05），균구유통계학의의。불동지구적농민년균수입각항득분、불동지부방식지구적각항득분비교（P<0.05），구유통계학의의。결론：유효가강의보지부적비용공제，제고농민실제수익수평；개선경판궤구조건，가쾌의보지부방식개혁；충분조동정점의료궤구적적겁성，제고의원복무질량。
Objective: To explore the effect and problems of the outpatient insurance payment of new rural cooperative medical system in Heilongjiang. Methods: Based on the questionnaires from 60 office managers in different areas, getting the classification of outpatients’ payment effect and problems through explore factor analysis; comparing scores of all items after using t-test; comparing scores of effect and existing problems of insurance payment in different areas by using rank sum test method. Results: The effect is divided into service quality and cost control. Existing problems are divided into the ’ problems of agencies and medical institutions. The difference of scores (P<0.05) is statistically significant. The scores of farmers’ average annual income in the agency’s problem and the differences of four items’scores in different payment areas (P<0.05), are statistical significant. Conclusion: Effectively strengthening the payment control, improving the farmers’actual beneficial levels; improving working condition of agencies, increasing the reform of insurance payment;arousing the enthusiasm of the medical institution and improving the quality of hospital ’s services.