基于ILO筹资模型的儿童口腔保险筹资水平研究——以四川省城镇职工家庭儿童为例

目的 估计四川省城镇职工家庭0~18岁儿童口腔保险的筹资水平,为儿童口腔保险的开展和政策制定部门提供参考意见。 方法 利用ILO模型对某专科口腔医院儿童口腔科7个月的门诊电子病历数据,结合全国第三次口腔流行病调查数据、国家卫计委等统计数据进行分析。 结果 将儿童口腔疾病诊断数据划分为3个等级,1级是预防性治疗,级别越高治疗程度越复杂。为了提高预防性治疗的使用率,预防性治疗100%的报销。按照级别越低报销程度越高的思路进行分级报销。利用ILO模型测算出2015年四川城镇儿童口腔保险筹资水平为每个儿童家庭缴纳保费125.04元/年,可以建立以预防为主的儿童口腔保险。 结论 结果显示较低的年费用就可以支撑以预防为主的儿童口腔保险的开展,建议卫生政策制定部门尽快将儿童口腔疾病纳入到基本医疗保险,可以更有效的保障儿童口腔健康。

Financing rate estimation based on ILO financing model for children dental insurance in Chengdu

Objective To estimate the dental insurance financing rate of 0-18-year-old children from an urban employed family of Sichuan Province.This financing rate could be referenced for dental healthcare policy makers. Methods Seven months medical record data of pediatric department in one dental specialist hospital was analyzed in this research.Data of the third dental epidemiology survey of China was also analyzed.The financing model from International Labor Office (ILO Model) was used to calculate the insurance fee. Results All the diagnosis data of pediatric dental department was divided into three levels.The first level was the preventive dental care.The higher level,the treatment was more complicated.According to the treatment level,different reimbursement rate was set.The preventive level was 100% reimbursed.The children dental insurance premium which was calculated by ILO model was 125.04 Yuan per year in 2015.This dental insurance was designed for focusing on the preventive dental care. Conclusion Children dental insurance premium is acceptable according to the preventive dental insurance designed thought.It suggests that health policy makers should take Children Dental Insurance into consideration as soon as possible for better children oral health.