上海儿童医疗保险制度报销水平实证分析  

Empirical analysis of reimbursement level of children's medical insurance in Shanghai

作　　者：任益炯[1] 江厚佳[2] 张云婷[1] 王汉松[1] 张录法[2] 江忠仪[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心党委办公室,上海200127 [2]上海交通大学国际与公共事务学院,上海200030

出　　处：《上海交通大学学报（医学版）》2012年第10期1360-1363,共4页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市科委基金(11692105000);上海市卫生局基金(2010190)~~

摘　　要：目的调查分析当前儿童大病重病的疾病经济负担和在上海医疗保险制度中的实际报销水平,为完善上海市儿童医疗保障制度提供借鉴。方法收集上海三家儿童专科医院2008—2010年两类6种儿童大病重病1 917例患者的均次就诊费用资料,使用非参数检验方法对其进行分析。结果上海儿童大病重病患者的实际报销比例偏低,均值69.88%,未达到90%的要求值。不同类型大病重病的报销水平存在显著差异,最高为80.85%,最低仅为47.18%。6种疾病的少儿基金的报销比例均显著低于居民医疗保险的报销比例,差异有统计学意义(P=0.000)。结论上海儿童医疗保险制度有待完善,政府可考虑对上海儿童医疗保险制度进行整合,适当提高筹资水平和报销水平,提高儿童健康保障水平。Objective To investigate the economic disease burden and true level of reimbursement of children with serious illness in Shanghai,and to provide reference for the perfection of Shanghai children＇s medical insurance system.MethodsThe data of medical expense of 1 917 children with 6 types of serious diseases from 2008 to 2010 in three pediatric hospitals were collected,and the mean medical expense was analysed with non-parametric test.Results The true level of reimbursement of children with serious illness was relatively lower,with the average level of 69.88%,which was lower than the required value of 90%.Significant differences in reimbursement levels existed among different types of diseases,with the highest of 80.85% and the lowest of 47.18%.The reimbursement level of 6 types of serious diseases of Mutual Fund of Children Hospitalization was significantly lower than that of Basic Medical Insurance for Urban Residents（P=0.000）.Conclusion There is room for improvement of Shanghai children＇s medical insurance system.The integration of existing Shanghai children＇s medical insurance is advised,and the financing and reimbursement level should be elevated,so as to enhance the level of children＇s health insurance.

关 键 词：上海市 儿童医疗保险 大病重病 报销水平 

分 类 号：F842.6[经济管理—保险]