[1]钟港棚,徐 伟,刘朝一,等.门诊特殊疾病市级统筹方案设计——基于TOPSIS法[J].卫生经济研究,2021,38(9):45-48.
　ZHONG Gang-peng,XU Wei,LIU Chao-yi,et al.The Scheme Design of Municipal Overall Planning for Outpatient Special Diseases ——Based on TOPSIS Method[J].Journal Press of Health Economics Research,2021,38(9):45-48.
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门诊特殊疾病市级统筹方案设计
——基于TOPSIS法
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
38
期数:
2021年9期
页码:
45-48
栏目:
医保天地
出版日期:
2021-08-26

文章信息/Info

Title:
The Scheme Design of Municipal Overall Planning for Outpatient Special Diseases
——Based on TOPSIS Method
作者:
钟港棚1; 徐 伟1; 刘朝一1; 路娜娜1; 杜雯雯1
1.中国药科大学国际医药商学院， 江苏 南京 211198
Author(s):
ZHONG Gang-peng;  XU Wei;  LIU Chao-yi;  LU Na-na;  DU Wen-wen
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing Jiangsu 211198, China
关键词:
门诊特殊疾病; 市级统筹; TOPSIS法
Keywords:
outpatient special diseases;  municipal overall planning;  TOPSIS method
分类号:
F840.684
文献标志码:
B
摘要:
目的：设计H市门诊特殊疾病市级统筹方案，为我国门诊特殊疾病实现市级统筹提供参考。方法：对比分析全国各省会城市门诊特殊疾病政策，采用多数原则设计H市门诊特殊疾病市级统筹方案；基于H市医保结算明细数据得到不同方案的指标值，采用TOPSIS法评选出最优方案。结果：H市门诊特殊疾病市级统筹最优方案为职工和居民医保保障病种相同，不设置起付线，职工和居民医保的报销比例分别为80%和65%，在职职工、退休人员和居民的年度费用封顶线分别为2 000元、2 500元和1 600元。结论：门诊特殊疾病实现市级统筹过程中，建议合并扩大县级统筹区的病种范围，统一职工和居民医保的病种范围和数量，在县级统筹区补偿政策的基础上适当提高待遇水平。
Abstract:
Objective To design the scheme of the municipal overall planning for outpatient special diseases in H city, so as to provide reference for the realization of municipal planning for outpatient special diseases in China. Methods The outpatient special diseases policies of various provincial capitals in China were compared and analyzed, and the municipal overall planning plan for outpatient special diseases in H city was designed by using the majority principle. Based on the detailed data of medical insurance settlement in H city, the index values of different schemes were obtained, and the best scheme was selected by TOPSIS method. Results The optimal scheme of municipal overall planning for outpatient special diseases in H city is that employees and residents have the same types of medical insurance diseases, and there is no deductible line, and the reimbursement proportion of employees and residents medical insurance is 80% and 65% respectively. The annual cost capping lines for employees, retirees and residents are 2,000 yuan, 2,500 yuan and 1,600 yuan, respectively. Conclusion In the process of realizing the municipal overall planning for outpatient special diseases, it is suggested to merge and expand the scope of diseases in the county-level overall planning areas and unify the scope and quantity of diseases of medical insurance for employees and residents. The level should be appropriately improved on the basis of the compensation policy in the county-level overall planning area.

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更新日期/Last Update: 2021-08-26