耐多药肺结核诊疗费用在不同的医疗保障制度中的报销情况分析

目的了解中国全球基金耐多药肺结核防治项目覆盖的24省67地市患者诊疗费用在不同的医疗保障制度中的报销情况。方法设计专题调查表,以地市为单位收集24省67个地市2012年三种医疗保障制度（新型农村合作医疗制度、城镇居民基本医疗保险制度和城镇职工基本医疗保险制度）现况,计算住院和门诊费用能否报销和报销百分比,分别采用χ2检验和秩和检验对相应数据进行分析,P〈0.05为差异有统计学意义。结果住院费用纳入新农合、城居医保以及职工医保中报销的地市个数依次是60、58和55个;门诊费用纳入三种医保报销的地市个数依次是38、34和36个。住院费用在三种医保中的报销比例依次为70.00%（P25：65.00%,P75：75.00%）、70.00%（P25：60.00%,P75：70.00%）和80.00%（P25：72.00%,P75：87.00%）（χ2=36.10,P=0.000 1）;门诊费用在三种医保中的报销比例依次为60.00%（P25：27.00%,P75：70.00%）、60.00%（P25：43.00%,P75：70.00%）和80.00%（P25：50.00%,P75：85.00%）（χ2=11.26,P=0.003 6）。结论部分项目地区耐多药肺结核住院和门诊诊疗费用尚未纳入医疗保障中进行报销,报销比例有待进一步提高,尤其是门诊报销比例偏低,有待进一步加强。

Analysis on the reimbursement resistant tuberculosis under of medical expenses for multidrug three health insurance systems

Objective To discuss the reimbursement of medical expenses for multidrug resistant tuberculosis （MDRT） under three health insurance systems in Global Funding Project areas. Methods A self designed questionnaire survey was conducted in 67 counties from 24 provinces to collect the reimbursement information under three health insurance systems including New Rural Cooperative Medical System, the Basic Medical Insurance System for Urban Residents and the Basic Medical Insurance System for Urban Employee. Amount of reimbursement and reimbursement percentage were calculated. Chi square test and Kruskal-Wallis test were used for data analysis. Results Out of 67 counties, there were 60, 58, 55 counties in which inpatient costs were reimbursed with the percentage of reimbursement of 70.00% （P25： 65.00%, P75： 75.00%）, 70.00% （P25： 60.00%, P75： 70.00%） and 38, 34, 36 counties in which outpatient cost were reimbursed with the percentage of reimbursement of 80. 00% （P25.. 72.00%0, P75： 87.00%） （χ2=36.10, P= 0. 0001） under three health insurance systems. Conclusions The coverage of three medical insurance systems is still limit- ed, and the reimbursement percentage is low, especially for the outoatient medical costs.