我国罕见病“友好型”普惠险评价指标体系构建及应用探索

构建科学客观的罕见病“友好型”普惠险评价指标体系,为普惠险更好地参与罕见病多层次保障提供参考依据。文章以文献研究为基础,综合应用主成分分析法确定评价体系与指标权重,并对我国市面上保障范围不限制罕见病、基因型疾病或遗传性疾病的62款普惠险产品进行指标测算与应用。在保证基金稳定持续运营的基础上,为产品设置合理的既往症条款和责任免除条款;探索建立普惠险特药清单制度或地方性专项保障制度;在目录外住院自费保障的基础上,增加门诊的保障责任。

The Construction and Application of "Friendly" Inclusive Health Insurance Evaluation Index System for Rare Diseases in China

To construct a scientific and objective "friendly" inclusive health insurance evaluation index system for rare diseases, and to provide a reference basis for inclusive health insurance to better participate in the multi-level guarantee of rare diseases. On the basis of literature research, principal component analysis (PCA) is used to determine the evaluation system and index weight, and the index measurement and application of 62 inclusive health insurance in China that are not limited to rare diseases, genotype diseases or genetic diseases are also carried out. On the basis of ensuring the stable and continuous operation of the fund, reasonable pre-existing condition clauses and liability exemption clauses are set for the products. It explores the establishment of a general insurance list of special drugs or local special security system. On the basis of the insurance of out-of-catalogue hospitalization, the responsibility of outpatient service should be increased.