政策协同对贫困患者经济减负效果评价研究

贫困患者是医疗保险、医疗救助和健康扶贫专项政策的关注对象,减轻贫困患者疾病经济负担、防止"因病致贫、因病返贫"风险是政策协同目标。采用BRI、RR和C.V等指标以及整体、子群和个案视角,从识别精准和减负力度两个维度评价了政策协同对26 341名贫困患者减负效果,得出以下结论:(1)健康扶贫阶段性成效显著。政策协同综合BRI值达到0.82,共有73.22%个案处于相对安全区。(2)健康扶贫专项政策精准度和力度较好。专项补助BRI值为0.1,仅次于基本医保BRI值0.55;不仅使得所有疾病类型子群进入相对安全区,且对RR中、高风险区域个案减负效果显著。(3)健康扶贫专项政策需要重点关注30～39岁、住院多次以及先天性畸形、变形和染色体异常等子群。建议:(1)政策协同减负效果显著、巩固健康扶贫专项补助精准靶向作用。(2)完善各类政策协同机制、关注防范重点人群因病致贫风险。(3)加强政策评价方法研究、提供多视角多维度量化评估工具。

Evaluation of the effect of policy coordination on economic burden reduction for impoverished patients

Impoverished patientsare the major concerns of series polices such as medical insurance, medical assistance and other special policies for health poverty alleviation. The commonly shared and synergy goals of all these policies is to lighten the economic burden of medical costs on impoverished patients and to reduce the risk of "illness-induced poverty and reinstatement of poverty due to diseases and treatment costs". From the two dimensions of recognition accuracy and burden reduction, this paper estimated the burden reduction effects on 26341impoverished patients as a whole,in several groups,and as a case example by using indicators such as BRI, RRand C.V. and brought about three conclusions. (1)The stage effect of health poverty alleviationwas remarkable with a comprehensive policy BRI of 0.82 and about 73.22% cases in relatively safe areas. (2)The recognition accuracy and burden reduction effect of special policies for health poverty alleviationwere quite good both in all groups divided by diseases and all cases in medium RR and high-risk areas, with a BRI of 0.1 which is second only to medical insurance whose BRI was 0.55. (3)Special policies for health poverty alleviation should pay more attention to groups such as ages range of 30~39, multiple hospitalizations and congenital malformations, deformities, and chromosomal abnormalities. After observations, this paper puts forward two suggestions, i.e. the cooperative burden reduction effect of series polices is remarkable and precise targeting of special subsidies for health poverty alleviation should be strengthened; the cooperative mechanisms of series polices should be improved and more attention should be paid on the focus group''s risk of illness-induced poverty; and the policy evaluation methods need more multi-perspective and multi-dimensional quantitative evaluation tools.