[1]徐冰冰,丁锦希,李 伟.惠民保门诊慢特病衔接保障评价体系构建及应用[J].卫生经济研究,2024,41(11):50-53.
　XU Bingbing,DING Jinxi,LI Wei.Construction and Application of Evaluation System for the Connection Guarantee of Outpatient Chronic and Special Diseases in Inclusive Commercial Health Insurance[J].Journal Press of Health Economics Research,2024,41(11):50-53.
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惠民保门诊慢特病衔接保障评价体系构建及应用
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
41
期数:
2024年11期
页码:
50-53
栏目:
医疗保障
出版日期:
2024-10-31

文章信息/Info

Title:
Construction and Application of Evaluation System for the Connection Guarantee of Outpatient Chronic and Special Diseases in Inclusive Commercial Health Insurance
作者:
徐冰冰1; 丁锦希1; 2; 李 伟1
1.中国药科大学国际医药商学院，江苏 南京 211198
2.中国药科大学医药市场准入政策研究中心，江苏 南京 211198
Author(s):
XU Bingbing;  DING Jinxi;  LI Wei
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing Jiangsu 211198, China
关键词:
门诊慢特病; 惠民保; 衔接保障; 评价体系
Keywords:
outpatient chronic and special diseases;  inclusive commercial health insurance;  connection guarantee;  evaluation system
分类号:
R19
文献标志码:
A
摘要:
目的：构建惠民保与基本医保门诊慢特病保障衔接的评价指标体系，指导惠民保产品的设计和优化。方法：采用主成分分析法确定指标体系与指标权重，对全国96款惠民保产品门诊慢特病衔接保障进行评价。结果：从保障性评估和可持续性评估两个维度，构建评价指标库；惠民保产品门诊慢特病衔接保障评价的综合得分集中在中值附近，衔接保障效果比较均衡。结论：衔接保障较优的惠民保产品呈现三大特点——重视普通门诊保障，理赔限制和程序友好，产品的性价比较高；这些也是未来惠民保设计和优化的重点。
Abstract:
Objective To construct an evaluation index system for the connection between inclusive commercial health insurance and basic medical insurance for outpatient chronic and special diseases, and guide the design and optimization of inclusive commercial health insurance products. Methods Principal component analysis was used to determine the index system and index weight, and the connection guarantee for outpatient chronic and special diseases in 96 inclusive commercial health insurance products in China were evaluated. Results From the two dimensions of guarantee evaluation and sustainability evaluation, the evaluation index library was constructed. The comprehensive score of the evaluation of connection guarantee for outpatient chronic and special diseases in inclusive commercial health insurance products was concentrated near the median value, and the connection guarantee effect was relatively balanced. Conclusion Inclusive commercial health insurance products with better connection guarantee have three characteristics: paying attention to the general outpatient care guarantee, fewer restrictions on claims and more convenient for claims, and higher cost performance. These are also the focus of the design and optimization of inclusive commercial health insurance in the future.

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更新日期/Last Update: 2024-10-31