[1]朱 斌,张 宁,何荣鑫,等.重特大疾病保障政策的实践与效果——基于延安市的实证研究[J].卫生经济研究,2022,39(2):14-18.
　ZHU Bin,ZHANG Ning,HE Rong-xin,et al.Practice and Effect of Critical Illness Insurance Policy——Empirical Research from Yan'an City[J].Journal Press of Health Economics Research,2022,39(2):14-18.
点击复制

重特大疾病保障政策的实践与效果
——基于延安市的实证研究
分享到：

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
39
期数:
2022年2期
页码:
14-18
栏目:
医疗保障
出版日期:
2022-01-27

文章信息/Info

Title:
Practice and Effect of Critical Illness Insurance Policy
——Empirical Research from Yan'an City
作者:
朱 斌1; 张 宁2; 何荣鑫2; 宁 伟2; 谢 涛2; 鲁永博2; 柳锦楠2; 毛 瑛2
1.南方科技大学公共卫生及应急管理学院，广东 深圳 518055
2.西安交通大学公共政策与管理学院， 陕西 西安 710049
Author(s):
ZHU Bin;  ZHANG Ning;  HE Rong-xin;  NING Wei;  XIE Tao;  LU Yong-bo;  LIU Jin-nan;  MAO Ying
School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen Guangdong 518055, China
关键词:
重特大疾病; 多层次医疗保障; 基本医疗保险; 大病保险; 医疗救助
Keywords:
critical illness;  multi-level medical insurance;  basic medical insurance;  critical illness insurance;  medical assistance
分类号:
F840.684
文献标志码:
A
摘要:
目的：分析多层次医疗保障制度对重特大疾病的实际保障效果。方法：分地区、总费用水平和病种计算延安市基本医疗保险、大病保险和医疗救助对重特大疾病的保障效果。结果：延安市重特大疾病医疗费用经基本医疗保险、大病保险和医疗救助三个层次的报销后，平均保障水平为77.14%；住院医疗费用的补偿比例随总费用上升而下降；总费用超过20万元的患者，个人自付比例超过35%。结论：持续完善医保药品目录、诊疗项目目录，在目录层面实现对基本诊疗需求的全覆盖，同时重视高额医疗费用的补偿，增强制度的兜底保障作用；各统筹地区应结合本地区实际，出台相适应的重特大疾病保障政策，做到精准施策。
Abstract:
Objective To analyze the actual security effect of the multi-level medical insurance system on critical illness. Methods This paper estimated the effect of basic medical insurance, critical illness insurance and medical assistance on critical illness in Yan'an city stratified by region, total cost level and disease. Results The average reimbursement rate was 77.14% for critical illness after reimbursement from basic medical insurance, critical illness insurance and medical assistance. The reimbursement of inpatient medical costs decreased with the increase of total expenses. For patients whose total expenses were over 20 thousands (RMB), the personal out-of-pocket ratio exceeded 35%. Conclusion It is necessary to improve the reimbursement list of drugs and medical items, so that full coverage of basic medical needs could be achieved by reimbursement list support. Also, it is suggested to pay attention to compensation for high medical expenses, in order to strengthen the guarantee for urgent-need groups. And governments in reimbursement pools should introduce relative policies about critical illness insurance based on their practices.

参考文献/References:

[1] 董克用，郭珉江，赵斌.“健康中国”目标下完善我国多层次医疗保障体系的探讨[J].中国卫生政策研究，2019，12（1）：2-8.
[2] 胡晓梅，邓绍平，胡锦梁.多层次医疗保障体系发展的国际经验借鉴与展望[J].卫生经济研究，2021，38（7）：51-54.
[3] 谢明明，刘珏岑，吴国哲.建档立卡贫困人口医疗保障政策效果研究——基于改善灾难性卫生支出的视角[J].卫生软科学，2020，34（9）：28-32.
[4] 黄秀芹，陈民，孔旭辉，等.新农合重大疾病保障及大病保险政策实施效果分析——以泰州市某三级综合性医院为例[J].卫生软科学，2016，30（10）：14-16,20.
[5] 荆涛，杨舒.商业健康保险在多层次医疗保障体系中的地位与发展现状[J].中国医疗保险，2016（6）：18-22.
[6] 王毓丰，陈永法.商业保险衔接基本医疗保险的国际经验及启示[J].卫生经济研究，2019（9）：60-64.
[7] 黄德斌，黄洋.成都市完善多层次医疗保障体系的进程与实效分析[J].中国医疗保险，2018（10）：44-46,50.

相似文献/References:

[1]陈永成,田博韬,郑先平.完善低收入人口多层次医疗保障制度的路径研究[J].卫生经济研究,2023,40(8):69.
　CHEN Yongcheng,TIAN Botao,ZHENG Xianping.Study on the Paths to Improve the Multi-level Medical Security System for Low-income Population[J].Journal Press of Health Economics Research,2023,40(2):69.
[2]胡杨木,刘 敬,钟碧霞,等.普惠型商业医疗保险的保障效果研究[J].卫生经济研究,2024,41(02):27.
　HU Yangmu,LIU Jing,ZHONG Bixia,et al.Study on the Protection Effect of Inclusive Commercial Medical Insurance[J].Journal Press of Health Economics Research,2024,41(2):27.
[3]谭清立,黄朝凤.重特大疾病医疗保险和救助制度现状研究 ——基于政策工具理论[J].卫生经济研究,2024,41(03):27.
　TAN Qingli,HUANG Chaofeng.Study on the Current Situation of Medical Insurance and Assistance System for Major and Serious Diseases ——Based on the Theory of Policy Instruments[J].Journal Press of Health Economics Research,2024,41(2):27.

更新日期/Last Update: 2022-01-27