摘要目的：分析县级公立医院改革对新型农村合作医疗住院患者费用的影响。方法选取湖北省 D 县2012年1月至2013年6月的30107例新型农村合作医疗患者住院数据，采用双重差分模型(DID)，计算实施改革政策前后的住院费用等变化值，最后得出 DID 估计值。结果改革试点组的次均住院费用上升了640元(P =0.000)；住院补偿比提高了3.4%(P =0.000)，但患者的自付费用上升了192元(P =0.048)。从分类费用的变化来看，改革试点组的药费下降了89元(P =0.084)，但检查费、治疗费、诊疗费、手术费和其他费用却出现上涨。此外，改革政策对不同疾病的影响呈现不同特征，对普通疾病的政策影响明显高于心脏疾病。结论应注意改革的系统性，对财政补偿、服务价格定位、医生薪酬支付方式、绩效管理、规范医疗行为等进行综合考虑，才有可能达到综合改革的目标。

abstractsObjective To learn the impacts of county public hospital reform on NCMS inpatient expenditure.Methods Data of 30 107 NCMS-covered inpatients were extracted from county of the province,in the timeframe of January 1,2012 to June 30,2013.The difference-in-differences (DID) approach was used to estimate such values as the pre-and post-reform changes as hospitalization spending among others,and reach an estimated DID value.Results We found that the inpatient spending for reform pilot group increased CNY 640 per hospitalization (P = 0.000 ),and the reimbursement ratio increased by 3.4% (P =0.000).The patient out-of-pocket spending however increased by CNY 1 92(P =0.048).Changes in the spending per category indicate a drop of CNY 89(P =0.084)in the reform pilot group,but an increase of such other spending as examination,treatment,diagnosis,surgery among others.The impacts of the reform policies vary with diseases,which are much higher for common diseases than heart diseases.Conclusions The reform calls for attention to its systematic nature.The financial subsidy,service pricing,payment of physicians,performance management,and regulation of medical behaviors should be taken into a general consideration,accomplishing the general goal of the reform.