我国城市社区高血压患者医疗保险就医管理模式探讨

目的 探讨我国城镇高血压患者适宜的医疗保险就医管理模式,提高医疗保险经办机构的管理水平和管理质量.方法　采用结构式问卷对高血压患者进行问卷调查,对社区卫生服务中心和医疗保险管理中心的相关工作人员进行定性访谈.结果　高血压患者的就医流向主要集中在社区和三级医院;不同地区的高血压患者对现有医疗保险有不同程度的不满意,主要体现在报销手续繁琐、起付线高和报销水平低等方面.讨论试行高血压的单病种支付,实行按人头和病种的总额预付的支付方式;加强社区高血压管理,医疗保险相关政策向社区倾斜;加强各级医疗机构合作,建立和完善高血压患者的规范管理信息网络.

Abstract：

Objective To probe into a doctor-seeking medical management model for China's urban hypertension patients under medical insurance, and enhance the level and quality of medical insurance management. Methods Hypertension patients were surveyed with a structured questionnaire, and the staff at community health centers and medical insurance management centers received qualitative interview. Results The hypertension patients are found to see doctors mostly at community health centers and tertiary hospitals; complaints among hypertension patients for existing medical insurance vary with their areas, mostly targeting on complicated reimbursement procedure, high threshold of medical insurance payment and low level of reimbursement. Recommendation Experiment with the single-disease payment for hypertension, with the total prepayment in per capita and per disease; greater efforts in hypertension control in communities, with more favorable medical insurance policies for communities;elevated collaboration with medical institutions at all levels, and building and standardizing the management information network for hypertension patients.

Appropriate doctor-seeking management model for hypertension patients under medical insurance in China's urban communities

Objective To probe into a doctor-seeking medical management model for China's urban hypertension patients under medical insurance, and enhance the level and quality of medical insurance management. Methods Hypertension patients were surveyed with a structured questionnaire, and the staff at community health centers and medical insurance management centers received qualitative interview. Results The hypertension patients are found to see doctors mostly at community health centers and tertiary hospitals; complaints among hypertension patients for existing medical insurance vary with their areas, mostly targeting on complicated reimbursement procedure, high threshold of medical insurance payment and low level of reimbursement. Recommendation Experiment with the single-disease payment for hypertension, with the total prepayment in per capita and per disease; greater efforts in hypertension control in communities, with more favorable medical insurance policies for communities;elevated collaboration with medical institutions at all levels, and building and standardizing the management information network for hypertension patients.