基于医疗服务需求的健康扶贫政策医疗保险资金需求分析  

Analysis ofthe need for medical insurance funds based on healthcare demand of Health Poverty Alleviation Policy

作　　者：薛秋霁 蒋俊男 辛艳姣 王雪峰 项莉[2] XUE Qiu-ji;JIANG Jun-nan;XIN Yan-jiao;WANG Xue-feng;XIANG Li(Center for Monitoring and Verification of Low Income Families,Beijing 100054,China;Tongji Medical college,Huazhong University of Science and Technology,Wuhan Hubei 430030,China)

机构地区：[1]民政部低收入家庭认定指导中心,北京100054 [2]华中科技大学同济医学院,湖北武汉430030

出　　处：《中国卫生政策研究》2019年第6期47-51,共5页Chinese Journal of Health Policy

基　　金：国家自然科学基金(71573095)

摘　　要：目的:分析建档立卡人群的住院服务利用和医疗费用现状,衡量健康扶贫政策实施后所增加的医疗保险基金需求。方法:利用湖北省A地2016年新农合补偿数据库,采用描述性方法和保险精算法。结果:建档立卡人群住院率、平均住院天数、住院次数、人均住院总费用均高于非建档立卡人群。由于健康扶贫政策的实施,该地区人均筹资需要增加15.8元,其中11.7元用于基本医保补偿,4.1元用于大病保险报销。结论:建档立卡人群的住院服务需求明显高于非建档立卡人群,各地区应合理测算健康扶贫政策带来的资金需求,保证政府对健康扶贫增加的投入,合理使用医保基金。加强部门合作,建立多路径健康保障体系。Objectives:This research is made to analyze the status of inpatient service consumption and medical expenses of poor households,and to measure the trend of increase in demand for health insurance funds after the Health Poverty Alleviation Policy implementation.Methods:This paper uses the 2016 New Rural Cooperative Medical System Compensation Database from Hubei Province,Area A,and adopts descriptive methods and insurance precision algorithms to get desirable results.Results:The hospitalization rate,the average hospitalization time and period,and the per capita hospitalization cost for poor households were higher than those attributed to rich households,being estimated at 12.4%.Due to the Health Poverty Alleviation Policy implementation,the per capita fundraising in the region needs to increase by 15.8RMB of which 11.7RMB is for basic medical insurance compensation and the remaining 4.1RMB for catastrophic disease insurance payment.Conclusion:The results found that the inpatient service demand of poor households is significantly higher than that of well-off families.All regions should reasonably make a good quotation of need for funds during the Health Poverty Alleviation Policies,ensure that the government has provided enough investment in the policies designed to alleviate health-related poverty,and rationally use the medical insurance funds.Therefore,the departmental collaboration should be strengthened and a multi-path health security system established.

关 键 词：医疗服务需求 健康扶贫政策 贫困户 基金 

分 类 号：R197[医药卫生—卫生事业管理]