[1]武若瑜,邹海燕,俞纯璐,等.门诊慢特病医疗保障省级统筹的思考与建议[J].卫生经济研究,2023,40(10):49-52.
　WU Ruoyu,ZOU Haiyan,YU Chunlu,et al.Thoughts and Suggestions on Provincial-level Overall Planning of Medical Security for Chronic and Special Critical Diseases in Outpatients[J].Journal Press of Health Economics Research,2023,40(10):49-52.
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门诊慢特病医疗保障省级统筹的思考与建议
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
40
期数:
2023年10期
页码:
49-52
栏目:
医疗保障
出版日期:
2023-09-28

文章信息/Info

Title:
Thoughts and Suggestions on Provincial-level Overall Planning of Medical Security for Chronic and Special Critical Diseases in Outpatients
作者:
武若瑜1; 邹海燕1; 俞纯璐1; 张璐莹1
1.复旦大学公共卫生学院，上海 200032
Author(s):
WU Ruoyu;  ZOU Haiyan;  YU Chunlu;  ZHANG Luying
School of Public Health, Fudan University, Shanghai 200032, China
关键词:
基本医疗保险; 门诊慢特病; 医疗保障待遇; 省级统筹
Keywords:
basic medical insurance;  chronic and special critical diseases;  medical security benefits;  provincial-level overall planning
分类号:
F840.684
文献标志码:
A
摘要:
目的：分析门诊慢特病医疗保障现状，提出实现省级统筹的建议。方法：收集N省门诊慢特病政策文件，定量、定性分析各统筹区门诊慢特病的病种目录、报销水平、认定标准等医疗保障待遇。结果：全省各统筹区纳入的门诊慢特病为17~72种，仅8个病种被所有统筹区纳入；起付线、报销比例、支付限额均存在较大差距；病种认定标准定性描述居多，医疗保障待遇设定方式不同。结论：建立省级门诊慢特病病种目录，提升待遇公平性，由病种保障转向费用保障；统一病种认定标准，规范认定流程；区分病种设置待遇水平，提高报销比例；同步推进医保支付方式改革，提高基金支付效率。
Abstract:
Objective To analyze the current situation of medical security for chronic and special critical diseases in outpatient clinics, and to propose suggestions for achieving provincial-level overall planning. Methods The policy documents on chronic and special critical diseases in outpatient clinics of N province were collected and quantitative and qualitative analysis has been conducted on the disease categories, reimbursement levels, recognition standards, and other medical security benefits of chronic and special critical diseases in outpatient clinics of each coordinated area. Results There were 17-72 types of chronic and special critical diseases in outpatient clinics included in all coordinated areas of the province, with only 8 types included in all coordinated areas. There was a significant gap in the minimum payment line, reimbursement ratio, and payment limit. The qualitative description of disease identification standards was mostly used, and the methods of setting medical security benefits were different. Conclusion It is necessary to establish a provincial directory of chronic and special critical diseases in outpatient clinics to improve the fairness of treatment and shift from disease protection to cost protection, unify the standards for disease identification and standardize the identification process, differentiate disease types and set treatment levels to increase reimbursement rates, and simultaneously promote the reform of medical insurance payment methods and improve the efficiency of fund payment.

参考文献/References:

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更新日期/Last Update: 2023-09-28