CAJ | 학술논문

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1160万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。
목적：평개신형농촌합작의료실시“안인두지부”개혁대삼합농민문진의료비용공제적효과。방법：수집포동신구“안인두지부”개혁실시전、후적신형농촌합작의료운행수거이급35만삼합농민2011-2012년1160만문진인차적취진비용、보상금액등수거병진행비교분석。결과：신형농촌합작의료지부방식개혁후，대우공제문진의료비용적과쾌증장유명현작용，진이유리우학보신형농촌합작의료기금수지평형。결론：목전，안인두지부개혁부사득사구위생복무궤구초보형성자아약속궤제，여하격려이、삼급의원의무인원주동공비，제정배투정책유대심입연구。
Objective: To evaluate the effect of controlling the outpatient medical expenses for participating farmers after the implementation of capitation reform under new rural cooperative medical system (NCMS). Methods: It collected the NCMS operational data before and after the implementation of capitation reform. The data included 11.6 million outpatient records about treatment cost , the amount of compensation and other data from 2011 to 2012. Results: After the capitation reform, the excessive growth of medical costs obtained a certain degree control, and the NCMS fund was more secure. Conclusion: Capitation reform only made an initial mechanism of self-restraint for community health service centers. Further studies are needed on how to motivate the staff in secondary and tertiary hospitals to control medical expense actively.