传染病医疗费用保障现状及完善策略:以肺结核为例  

Review of the present situation and improvement of the level of reimbursement related to infectious diseases medical care: Take tuberculosis as an example

作　　者：宋乐薇 姚岚[1] 陈山泉[2] 张颖[1] 巩方旭 咸越[1] 项莉[1] SONG Le-wei YAO Lan CHEN Shan-quan ZHANG Ying GONG Fang-xu XIAN Yue XIANG Li(School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan Hubei 430030, China The Jockey Club School of Public Health and Primary Care, the Chinese University of HongKong , Hongkong , China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030 [2]香港中文大学赛马会公共卫生学院

出　　处：《中国卫生政策研究》2016年第12期68-72,共5页Chinese Journal of Health Policy

基　　金：国家自然科学基金(71573095)

摘　　要：目的:以肺结核为例分析我国传染病医疗费用的保障水平,为完善相关保障策略提出建议。方法:利用UHC政策分析框架,从覆盖人群、覆盖项目和保障程度三个维度分析医保、免费诊疗政策和医疗救助对肺结核患者的保障水平。结果:新农合对肺结核住院患者的实际补偿比低于对全部患者的整体实际补偿比,门诊患者比住院患者补偿水平更低;免费药可及性高,但药品种类局限,利用率不如预期;医疗救助率高,覆盖面窄,无法提高肺结核患者整体保障水平。结论:医保对传染病患者的医疗费用保障水平有限;传染病治疗是准公共产品,应强化政府在医保、免费诊疗政策和医疗救助的责任,进一步提高传染病的医疗费用保障水平。Purpose ： Taking tuberculosis as an example, this paper aims at to analyzing the level of reimbursement for infectious diseases care, and clarifying the government responsibility. Methods： In order to achieve the objective of this research, UHC framework was used to analyze the security level. Result ： The findings of this research reveal that TB in-patients＇ Compensation Ratio of the New Cooperative Medical Scheme （NCMS） was lower than average level of all the NCMS patients, the out-patients＇was even lower. The categories of anti-tuberculotic for free was limited, the utilization was not as expected. Medical assistance covered few people in spite of its high level of reimbursement. Conclusion： Based on the findings of this review, it has been revealed that the medical insurance didn＇t make a big difference in financial protection for patients with infectious diseases. As the treatment for of infectious diseases is a quasi-public good, the government has to shoulder the responsibility of improving the compensation ratio of the patients.

关 键 词：传染病 医疗保险 免费诊疗政策 医疗救助 政府责任 

分 类 号：R197[医药卫生—卫生事业管理]