大病保险对农村居民医疗费用负担及其公平性影响  

The Effect of the Catastrophic Health Insurance on the Intensity and Equity of Rural Residents’ Medical Expenses Burden

作　　者：徐维维[1,3] 许汝言 陈文 胡敏[1,2] XU Wei-wei;XU Ru-yan;CHEN Wen(Shanghai 10th People's Hospital,Shanghai,200072,China)

机构地区：[1]复旦大学公共卫生学院,上海200032 [2]国家卫生健康委卫生技术评估重点实验室(复旦大学),上海200032 [3]上海市第十人民医院,上海200072

出　　处：《中国卫生经济》2019年第7期23-26,共4页Chinese Health Economics

基　　金：国家自然科学基金资助项目(71303056);美国中华医学基金会公开竞争项目(13-163)

摘　　要：目的:评估大病保险对宁夏农村居民医疗费用负担及其公平性影响,为完善大病保险提供合理的政策建议。方法:利用宁夏农村地区入户调查数据,模拟比较大病保险报销前后居民自付费用水平、家庭灾难性卫生支出发生风险及其在人群中分布的变化。结果:大病保险有效降低了住院自付费用及家庭灾难性卫生支出的发生风险,有助于医疗费用负担的减轻;但从分布来看,大病保险报销虽然改善了人群中自付费用的分布,但也出现了灾难性卫生支出的发生更向贫困家庭集中的趋势。结论:针对目标人群,大病保险政策效果较为显著,但需要进一步完善基本医疗保险制度,做好大病保险政策与其他医疗保障政策的衔接,全面发挥多层次医疗保障体系的作用,并加大消除贫困政策力度,以此减少人群中特别是贫困家庭的医疗费用负担及其发生灾难性卫生支出的风险。Objective:To evaluate the effect of the catastrophic health insurance on the intensity and equity of rural*residents medical expenses burden in Ningxia.Methods:Based on the household survey data of Ningxia rural areas,stimulation of catastrophic health insurance and prediction of its effect on medical financial burden and equity was performed.Results:Catastrophic Health Insurance effectively reduced i*npatients out-of-pocket(OOP)health expenditure and the risk of household catastrophic health expenditure,which mitigated the burden of medical expenses.Although the incidence of catastrophic medical insurance reimbursement improved the distribution of OOP,the catastrophic health insurance was relatively more concentrated in poorer households.Conclusion:The effect was relatively remarkable for the target group.The policy deserved to be extended to a certain extent,simultaneously made a good performance of the convergence of catastrophic health insurance and other medical insurance policy,decreased the medical expense burden(especially among the poor families)and the risks of of catastrophic medical insurance.

关 键 词：农村居民 大病保险 医疗费用 公平性 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F840.684[经济管理—保险]