摘要
目的:了解我国社区卫生服务机构基本医疗保险制度实施现状。方法:在2007—2009年对36个社区卫生服务重点联系城市(区)所有社区卫生服务机构进行普查,采用非参数检验对医保定点与非定点机构进行比较分析。结果:社区卫生服务中心和站纳入医保定点的比例从2007年的89.81%和45.59%增至2009年的95.77%和60.82%;2009年社区卫生服务机构城镇职工医保和城镇居民医保的平均起付线分别为387.21元和272.07元,自付比例分别为26.42%和39.79%;2007—2009年社区卫生机构门急诊和住院服务量呈增长趋势,2009年中心和站日均门急诊量已达218.13人次和37.78人次,中心住院27.06床日、出院2.57人次,中心和站门诊次均费用分别为88.62元和62.15元;医保定点机构的医保收入占业务收入的比重也呈逐年上升趋势,2009年中心和站这一比例已分别达到41.03%和38.25%。结论与建议:医保定点社区卫生服务机构整体发展呈现向好趋势,但基本医保制度的政策潜力有待进一步发挥,医保效用的提升空间很大,应充分发挥医保对社区卫生服务机构的监管和调控作用,加大补偿力度,提高保障水平。
Objectives：To understand the basic medical insurance system implementation status in community health service institutions（CHIs）.Methods：A repeated survey was conducted in all CHIs in 36 cities（district） in 2007—2009.Non-parametric test was applied to analyze the designated and non-designated CHIs.Results：The proportion of community health service centers（CHCs） and stations（CHSs） designated by medical insurance had been steadily increasing,from 89.81% and 45.59% respectively in 2007 to 95.77% and 60.82% respectively in 2009.The deductible of the urban employee and resident basic medical insurances for the CHIs were 387.21 Yuan and 272.07 Yuan respectively,and the copayment rates were 39.79% and 26.42% respectively.There was an obvious increase in CHI outpatient and inpatient services volume in the three years,the daily average number of outpatients in the CHCs and CHSs were 218.13 and 37.78 respectively,and the daily average number of inpatient bed days was 27.06 and the average number of daily discharged inpatients was 2.57 in the CHCs,and the average cost of outpatient in the CHCs and CHSs were 88.62 Yuan and 62.15 Yuan in 2009;meanwhile,there was an increasing trend of the medical insurance revenue as a proportion of total revenue in the designated CHCs and CHSs,and they were 41.03% and 38.25% respectively in 2009.Conclusions and recommendations：The designated CHIs are performing well.The policy design of CHIs medical insurance system is yet to be improved,the potential of medical insurance policies needs further strengthening.Medical insurance needs to strengthen the supervision and regulation to the CHIs in order to further improve the medical insurance＇s effect.
出处
《中国卫生政策研究》
2011年第6期11-16,共6页
Chinese Journal of Health Policy
基金
卫生部全国社区卫生服务体系建设重点联系城市基线调查与常规监测项目(NPMO40)
关键词
社区卫生服务
医疗保险
重点联系城市
现状
Community health service
Medical insurance
Key contact city
Status
