| 成都市重特大疾病医疗保障水平研究——基于肺和支气管恶性肿瘤患者医疗费用保障水平及评价分析 |
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| 引用本文： | 李尚乐1,2,张雨萌1,2,邓宇帆1,2,吴奎3,潘杰1,2. 成都市重特大疾病医疗保障水平研究——基于肺和支气管恶性肿瘤患者医疗费用保障水平及评价分析[J]. 现代预防医学, 2022, 0(16): 2980-2985. DOI: 10.20043/j.cnki.MPM.202202369 |
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| 作者姓名： | 李尚乐1 2 张雨萌1 2 邓宇帆1 2 吴奎3 潘杰1 2 |
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| 作者单位： | 1. 四川大学华西公共卫生学院/华西第四医院，四川 成都 610041；2. 四川大学西部农村卫生发展研究中心，四川 成都 610041；3. 成都市医疗保障局，四川 成都 610041 |
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| 摘 要： | 目的 在我国多层次医疗保障体系不断发展完善的背景下，文章以成都市为例，对重特大疾病保障水平进行测度与评价。方法 利用成都市医保结算数据，对基本医保、补充医保对肺和支气管恶性肿瘤患者的经济补偿效果进行研究，以“实际补偿比”作为保障水平的度量指标，引用“底线补偿比”和“患者自付比例”对保障水平予以评价。结果 2013—2020年住院患者实际补偿比在57%～86%之间，2014—2020年门特患者实际补偿比在75%～97%之间，且住院实际补偿比超过了20%阈值下的底线补偿比，门特实际补偿比超过了5%阈值下的底线补偿比。从患者自付比例来看，除了三级医院住院患者，其他情形下均达到了我国2030年个人自付占比为25%的目标。结论 成都市对重特大疾病患者已实现相对较高的保障水平，这得益于成都市医保敢开先河，不断构建完善的多层次医疗保障体系。
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| 关 键 词： | 重特大疾病 保障水平 补偿比 |
Study on medical coverage level for catastrophic diseases in Chengdu: based on the level of medical cost coverage and evaluation analysis for patients with lung and bronchial malignancies |
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| LI Shang-le,ZHANG Yu-meng,DENG Yu-fan,WU Kui,PAN Jie. Study on medical coverage level for catastrophic diseases in Chengdu: based on the level of medical cost coverage and evaluation analysis for patients with lung and bronchial malignancies[J]. Modern Preventive Medicine, 2022, 0(16): 2980-2985. DOI: 10.20043/j.cnki.MPM.202202369 |
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| Authors: | LI Shang-le ZHANG Yu-meng DENG Yu-fan WU Kui PAN Jie |
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| Affiliation: | *West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China |
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| Abstract: | Objective To measure and evaluate the level of protection for catastrophic diseases in the context of the development and improvement of China’s multi-level medical insurance system, taking Chengdu as an example. Methods Using the settlement data of medical insurance in Chengdu, we studied the financial compensation effect of basic medical insurance and supplementary medical insurance for patients with lung and bronchial malignancies. The level of coverage was evaluated by referencing to “bottom-line compensation ratio” and “patient out-of-pocket ratio”, using the “actual compensation ratio” as a measure of the level of coverage. Results The actual reimbursement ratio for inpatients from 2013 to 2020 ranged from 57% to 86%, exceeding the bottom-line reimbursement ratio under the 20% threshold, and the actual reimbursement ratio for outpatients from 2014 to 2020 ranged from 75% to 97%, exceeding the bottom-line reimbursement ratio under the 5% threshold. In terms of the patient out-of-pocket ratio, except for tertiary hospital inpatients, China’s 2030 target of a 25% personal out-of-pocket ratio was met in all cases. Conclusion Chengdu has reached a relatively high level of protection for patients with catastrophic diseases, thanks to the fact that the city’s medical insurance has dared to set a precedent by continuously improving the multilevel medical protection system. |
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| Keywords: | Catastrophic diseases Coverage level Reimbursement ratio |
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