贵阳市5岁以下儿童服务利用及医保待遇比较研究  

A comparative study on utilization of service and medical insurance benefits for children under 5 years in Guiyang city

作　　者：童雪涛[1] 许宗余[2] 郭素芳 陈可君[4] 姚岚[4] 熊巨洋[4] 

机构地区：[1]贵阳医学院 [2]卫生部妇社司儿保处 [3]联合国儿童基金会驻北京办事处 [4]华中科技大学同济医学院,湖北武汉430030

出　　处：《中国妇幼保健》2011年第24期3768-3770,共3页Maternal and Child Health Care of China

基　　金：联合国儿童基金会项目〔YH601〕

摘　　要：目的:了解贵阳市5岁以下儿童医疗服务利用和医疗保险待遇现状,分析不同医疗保险儿童保险待遇差异及影响因素,为进一步完善贵阳市儿童医疗保障制度提供理论依据和政策建议。方法:定性资料来源于贵阳市儿童医疗保险政策文件和关键人物访谈,定量资料来源于470份5岁以下儿童家庭问卷。结果:5岁以下儿童月龄分布为(22.64±15.62)月,性别比为1.28∶1,5岁以下儿童未参加医疗保险比例为35.11%,城市有26.85%的儿童同时参加了商业保险;在乡镇卫生院住院儿童医疗保险补偿比例为55.59%,城市平均补偿比例为38.80%,应住院而未住院的只有0.90%;基层卫生机构普遍不具备新生儿重症监护室和新生儿疾病治疗的能力。结论:儿童住院服务利用情况较好,但补偿比较低,费用负担较重;同时基层儿科建设滞后,难以满足儿童健康需要;建议加强基层卫生机构儿科适宜设备的配置,提高儿科医生的培训和引进力度;逐步改善儿童保险待遇,提高报销比例。Objective：To understand the current situations of utilization of medical service and medical insurance benefits for children under 5 years in Guiyang city,analyze the difference of medical insurance benefits and the effect factors of children with different kinds of medical insurance,provide theoretical foundation and proposal for further perfecting the system of medical insurance of children in Guiyang city. Methods：The qualitative data was collected from the documents and interviews regarding children＇s health insurance policies,the quantitative data was collected from 470 questionnaires for families with children under 5 years. Results：The age of distribution of children under 5 years was（22.64 ± 15.62） months,and the sex ratio was 1.28 to 1.35.11% of the children under 5 years did not participate in health insurance,26.5% of the urban children participated in health insurance and commercial insurance.In township hospitals,55.59% of the hospitalized children had received medical insurance,in city,the proportion was 38.80%,0.90% of the children were supposed to be in hospital but they didn＇t;the primary health institutions generally didn＇t have neonatal intensive care unit and the ability to treat neonatal diseases. Conclusion：The utilization of hospital services of children is generally satisfactory,but the medical compensation is relatively low,therefore the cost is indeed much heavier.The construction of primary pediatric department is lagged,so it is difficult to meet the health needs of children.Efforts should be made to strengthen the equipment of pediatric department in primary health institutions and to improve the training and introduction of pediatricians,as well as to gradually improve the children insurance benefits and proportion for reimbursement.

关 键 词：5岁以下儿童 医疗服务 医疗保险 

分 类 号：R179[医药卫生—妇幼卫生保健]