Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China.
BMC Health Serv Res. 2013 Dec 17;13:519. doi: 10.1186/1472-6963-13-519.
China in 2009 committed to reach universal health coverage by promoting three forms of health insurance; NCMS for the rural population, UEBMI for formally employed urban residents and URBMI for other urban residents. NCMS has expanded to near universal coverage in rural China since launching in 2003. The objective of this study aimed to assess the effect of NCMS on inpatient care utilization from 2003 to 2012 at Longyou county hospital, Zhejiang province.
The research was conducted at Longyou county, Zhejiang province. All registered inpatient admissions from January 1, 2003, to June 30, 2012, were included in the study. The PLSQL Developer software was used to select the interesting variables in the hospital information database and saved in an Excel 2003 file. The interesting variables included the patients' general information (name, gender, age, payment method), discharge diagnosis, length of hospital stay, and expenditure (total expenditure and out-of-pocket payment). Two common diseases (coronary arteriosclerotic disease and pneumonia) were selected as tracer conditions.
292,400 rural residents were enrolled in the Longyou county NCMS by 2011, 95.4% of the eligible population. A total of 145,744 inpatient admissions were registered from 1 January 2003 to 30 June 2012. The proportion of inpatients covered by NCMS increased from 30.3% in 2004 to 54.2% in 2012 while the proportion of inpatients covered by UEBMI increased from 7.7% in 2003 to 14.7% in 2012. The average expenditure for UEBMI insured inpatients was higher than the average for NCMS insured inpatients, although the gap was narrowing. The average length of hospital stay increased every year for all inpatients, but was higher for UEBMI inpatients than for NCMS insured inpatients. For both tracer conditions the results were similar to the above findings.
NCMS has improved coverage height for its enrollees and resulted in increased cost of care per inpatient admission at the county hospital. However, wide differences persist between the two insurance systems in coverage height. Both systems are associated with increasing lengths of stay and rising cost per inpatient admission. We found that around 30% of inpatients were not covered by any of the two public health insurance systems, which calls for further studies.
中国于 2009 年承诺通过推行三种医疗保险形式来实现全民健康覆盖：针对农村人口的新型农村合作医疗制度、针对城镇职工的城镇职工基本医疗保险和针对其他城镇居民的城镇居民基本医疗保险。自 2003 年启动以来，新型农村合作医疗制度已在农村地区实现了近乎全覆盖。本研究旨在评估 2003 年至 2012 年浙江省龙游县医院新型农村合作医疗制度对住院患者利用的影响。
本研究在浙江省龙游县开展。所有 2003 年 1 月 1 日至 2012 年 6 月 30 日期间的住院患者均纳入研究。使用 PL/SQL Developer 软件选择医院信息数据库中的感兴趣变量，并将其保存到 Excel 2003 文件中。感兴趣的变量包括患者的一般信息（姓名、性别、年龄、支付方式）、出院诊断、住院时间和支出（总支出和自付支出）。选择两种常见疾病（冠状动脉粥样硬化性疾病和肺炎）作为示踪疾病。
截至 2011 年，龙游县共有 292400 名农村居民参加了新型农村合作医疗，覆盖了 95.4%的目标人群。2003 年 1 月 1 日至 2012 年 6 月 30 日期间共登记了 145744 例住院患者。新型农村合作医疗参保患者的比例从 2004 年的 30.3%增加到 2012 年的 54.2%，而城镇职工基本医疗保险参保患者的比例从 2003 年的 7.7%增加到 2012 年的 14.7%。城镇职工基本医疗保险参保患者的平均医疗费用高于新型农村合作医疗参保患者，但差距正在缩小。所有住院患者的平均住院时间逐年增加，但城镇职工基本医疗保险参保患者的平均住院时间高于新型农村合作医疗参保患者。两种示踪疾病的结果与上述发现相似。
新型农村合作医疗制度提高了参保人员的保障水平，导致县级医院每例住院患者的医疗费用增加。然而，两种保险制度在保障水平方面仍存在较大差距。两种制度均与住院时间延长和每例住院患者费用增加有关。我们发现，约 30%的住院患者没有参加这两种公共医疗保险中的任何一种，这需要进一步研究。
