我国不同地区非耐药肺结核患者医疗保障现状调查

目的了解我国不同地区非耐药肺结核患者的医疗保障现状及疾病经济负担,为国家制定相关政策提供参考依据。方法 2009年8月在东北、中部、东南沿海和西部地区分别选择一个地市,由培训合格的调查员使用统一设计的调查表在当地结核病防治机构随机抽取非耐药肺结核患者开展诊疗费用报销及社会经济状况调查。结果不同地区的医疗保险政策都不同程度地忽视门诊费用的报销,而是倾向于住院费用的报销,保障力度从高到低依次为职工医保、居民医保和新农合。尽管住院费用报销的实际执行力度高于门诊费用报销,但两者的执行力度均较弱。肺结核患者住院费用中约有12%～33%,门诊费用中约有24%～56%应报销但却未报销。目前,医疗保险政策对减轻患者疾病经济负担的作用仍不明显。非耐药肺结核患者实际支付医疗费用占家庭非食品性支出的比例约为54%～74%。结论我国不同地区非耐药肺结核患者的医疗保障水平有待提高,医疗保险政策的实际执行力度需要加强,以切实减轻患者的疾病经济负担。

Investigation on the current health insurance status of pulmonary tuberculosis cases without drug resistance in certain areas of China

Objective To investigate the current health insurance status and the financial burden of pulmonary tuberculosis cases without drug resistance(PTBWDR) in certain areas of China in order to provide basic evidence for making related national policies.Methods A retrospective survey was conducted about the reimbursement of medical expenses and socio-economic status of PTBWDR who were randomly selected from local TB institutes in the northeast,middle,southeast and west of China in August 2009.Results The survey revealed that according to the current healthcare policy,majority of inpatient costs could be reimbursed,but only a small portion of outpatient expense was given back to patients.Health insurance for city employees was the most guaranteed followed by that for urban local residents,while the new rural cooperative medical plan for rural farmers was the least.Although patients could get their partial medical expense back,but 12%-33% of inpatient costs and 24%-56% outpatient expenses which were supposed to be reimbursed actually were not given back to patients.So far health insurance plan did not really help to relieve the financial burden for patients with pulmonary tubculosis.In fact,medical bill payed by PTBWDR accounted for 54%-74% of total family non-food expenditure.Conclusions The overall health insurance policy should be implemented effectively and the medical plan for PTBWR in different areas of China should be greatly improved in order to relieve the economic burden of patients.