河南省某市中西医医疗保险补偿差异对比分析  

Comparatively Studying on the Differences of Medical Insurance Compensation Between Traditional Chinese Medicine and Western Medicine In One City of Henan Province

作　　者：许静[1] 张丽青[1] 仲利娟[1] 时立[1] 杜留洋 郑寒星 高婷[1] 

机构地区：[1]河南中医药大学,河南郑州450036

出　　处：《中国卫生事业管理》2017年第12期898-901,925,共5页Chinese Health Service Management

基　　金：河南省教育厅人文社科基地项目"医疗保险对中医药卫生服务影响研究"(编号:JD-2014-02);河南中医学院省属高校基本科研业务费专项项目"中医药NGO发展战略研究"(编号:2014KYYWF-ZZCX3-12);河南省卫计委课题"促进社会办医发展政策研究"(编号:YWZY201459)

摘　　要：目的:文章通过对比分析某市2011~2014年度医疗保险对中西医补偿的差异,为完善中西医补偿政策提出建议。方法:利用Excel软件对4年中西医医保补偿的摘要数据做描述性分析。结果:各年医保对西医药物补偿人次数所占比例约为46~48%,对西医药物补偿费用所占比例约为58~61%左右,对中医药物补偿人次数所占比例约为12~13%左右,对中医药物补偿费用所占比例约为11~12%左右,对西医疗法补偿人次数所占比例约为26~27%左右,对西医疗法补偿费用所占比例约为21~23%左右,对中医疗法补偿人次数所占比例约为11~12%左右,对中医疗法补偿费用所占比例约为2~6%左右。2011~2014年中医比西医药物医保少补偿的人次数比例差距扩大了6.92个百分点,少补偿的费用比例差距扩大了11.25个百分点;中医比西医疗法医保少补偿的人次数比例差距扩大了10.83个百分点,医保少补偿的费用比例差距扩大了14.19个百分点。结论:各年度医疗保险对中西医药物和疗法的补偿人次数和费用的构成比4年变化幅度不大;医保补偿以药物补偿为主,疗法补偿为辅;以西医药品和疗法补偿为主,以中医药物和疗法的补偿为辅。医疗保险加大了对中医的扶持力度,但中医比西医药物和疗法少补偿人次数和费用的比例差距仍然逐年扩大。Objective To comparatively study the differences of medical insurance compensation between Traditional Chinese Medicine （TCM） and Western Medicine （WM） from 2011 to 2014 in one city of Henan Province, and put forward suggestions for improving the compensation policy. Methods Data of medical insurance compensation from 2011 to 2014 was studied with descrip- tive analysis by software of Excel. Results For the Western Medicine, the constituent ratio of drug compensation person - time was 46 -48% , while the ratio of drug compensation expense was 58 -61%. For the Traditional Chinese Medicine, it was 12 -13 % and 11 - 12%, respectively. For the Western Medicine, the constituent ratio of medical treatment compensation person - time was 26 -27% , while the ratio of medical treatment compensation expense was 21 -23%. For the Traditional Chinese Medicine, it was 11 - 12% and 2 - 6%, respectively. The difference of drug compensation person - time between TCM and WM in four years increased by 6. 92%, while the difference of drug compensation expense increased by 11.25%. The difference of medical treat- ment compensation person - time between TCM and WM in four years increased by 10. 83% , while the difference of medical treat- ment compensation expense increased by 14. 19%. Conclusion The constituent ratios of compensation person - time and expenses of drugs and treatment of TCM and WM varied in limited range in past four years, which mainly compensated in drugs and in WM. Medical insurances on TCM need to be improved.

关 键 词：中西医 药物和疗法补偿 补偿人次数 补偿费用 差异对比 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]