CAJ | 학술논문

　　目的：寻找在支付方式改革背景下更佳的新农合基金使用状态，分析面临关键问题。方法：采用收支平衡系数法估测最佳平衡状态下的补偿率数值和构成。结果：当前湖北省新型农村合作医疗支付方式改革已经进入深水区，县级公立医院改革也在积极推进，湖北省取得了即时结算、支付方式改革与公立医院改革密切结合、受益水平不断提高的成绩，面临支付方式改革评价体系亟待建立、各地政策和受益水平相差较大、基金结余与补偿率偏低的矛盾、基金超支与不合理流向等困难。结论：亟待建立分级诊疗和双向转诊机制。
　　목적：심조재지부방식개혁배경하경가적신농합기금사용상태，분석면림관건문제。방법：채용수지평형계수법고측최가평형상태하적보상솔수치화구성。결과：당전호북성신형농촌합작의료지부방식개혁이경진입심수구，현급공립의원개혁야재적겁추진，호북성취득료즉시결산、지부방식개혁여공립의원개혁밀절결합、수익수평불단제고적성적，면림지부방식개혁평개체계극대건립、각지정책화수익수평상차교대、기금결여여보상솔편저적모순、기금초지여불합리류향등곤난。결론：극대건립분급진료화쌍향전진궤제。
Objective: To search for better fund payment status of new rural cooperative medical system ( NRCMS) under the background of payment system reform (PSR), the key problems are analyzed. Methods: The compensation rate and construction of the best balancing status are analyzed by using equilibrium coefficient method. Results: PSR of NRCMS has been deeply implemented in Hubei Province; the reform of county public hospitals is being promoted; instant calculation, payment reform and public hospital are closely related and the benefit is increasing. There are difficulties in the reform: the payment reform assessment system needs to be settled, policies and benefiting level vary widely, the fund surplus conflict with low compensation rate, overspending the fund, and unreasonable composition. Conclusion:Hierarchical diagnosis and treatment system and two-way referral system need to be established.