新农合重大疾病保障政策实施效果评价——基于北京市和海南省新农合住院患者数据

目的：分析北京市和海南省2012年新农合重大疾病保障政策实施效果,为完善相关政策提供依据。方法：以北京市和海南省为样本地区,选取白血病、先天性心脏病、乳腺癌、宫颈癌和重性精神病患者为研究对象,采用描述性统计和比较分析的方法,从政策覆盖范围和患者年度实际补偿比角度分析2012年新农合大病保障政策实施效果并进行地区间比较。结果：2012年两省市先心病和白血病的政策覆盖水平相对较高,其余三类大病政策覆盖率相对较低,区域间政策覆盖有差异;大病患者年度诊疗费用报销水平主要分布在50%左右,重性精神病和儿童两病的补偿比较高。结论：新农合大病保障政策在病种和区域间的覆盖存在差异;政策的实施明显减轻了患者的费用负担,但部分病种患者经济负担仍然较重,疾病单次诊疗费用高和补偿政策对诊疗次数的限制是其主要原因。建议：提高政策覆盖、缩小地区差异;进一步细化和完善补偿政策;提升疾病的规范化诊疗管理。

The effect evaluation of catastrophic disease insurance of New Rural Cooperative Medical Scheme: Based on inpatient medical records in Beijing and Hainan Province

Objective： To evaluate the effect of catastrophic disease insurance in the New Rural Cooperative Medical Scheme based on Beijing and Hainan inpatient records and to provide evidence for improving policy. Methods： Select Beijing and Hainan as the target regions, and 5 catastrophic heart disease, coverage rates breast cancer, and the actual cervical cancer, and severe mental illness） annual reimbursement rates for individuals. diseases （including leukemia, congenital as the target diseases, describe the policy Compare these indicators between regions and diseases. Results： In 2012, both regions revealed a higher policy coverage rate for patients with leukemia, congenital heart disease but a lower rate on other three diseases, while Beijing＇s total coverage rate is higher than Hainan. The actual annual reimbursement rate is about 50% and patients with severe mental illness, leukemia, congenital heart disease enjoy a higher reimbursement rate. Conclusion： There were a difference of policy coverage rates between regions and diseases, the effect of catastrophic disease insurance in New Rural Cooperative Medical Scheme is positive but partial amount of patients still suffered with heavy medical cost burden. High single-visit medical cost and the policy＇s limitation on reimbursement times would be the main causes. Suggestions： Narrowing the insurance benefit gap between regions should be emphasized during next stage; a more detailed policy guide should be made to ease patient＇s burden; a standard management on catastrophic diseases would also contribute to promoting patients＇ benefits.