某市医保统筹补偿对癌症患者门诊保障效果的研究  

Study on the Effect of Outpatient Pooling Funds Reimbursement of Medical Insurance on the Outpatient Guarantee of Cancer Patients in a City

作　　者：李湘君 唐力 卞琦娟 王中华[2] Li Xiangjun(School of Health Economics and Management,Nanjing University of Chinese Medicine,Nanjing,210023)

机构地区：[1]南京中医药大学卫生经济管理学院,南京210023 [2]南京医科大学医政学院,南京211166

出　　处：《医学与社会》2020年第7期119-123,129,共6页Medicine and Society

基　　金：国家社会科学基金资助项目,编号为18BGL243。

摘　　要：目的:考察某市城镇地区医保门诊补偿政策,分析医保统筹政策下癌症患者门诊费用的差异,为提高门诊保障水平,完善门诊保障机制提供依据。方法:应用统计学方法描述该市癌症患者的社会人口学特征,门诊统筹补偿制度下癌症患者门诊费用分布情况,应用logistic回归分析不同因素对癌症患者门诊费用和补偿比例的影响。结果:描述性统计分析结果显示,乳腺癌患者门诊人次占比(37.97%)和年门诊总费用(959.47元/人年)均高于其他4种癌症,肝癌患者的门诊人次总费用最高(76.79元/次)。5种癌症的医保门诊统筹比例存在差异,胃癌的补偿比例最高。多元回归结果表明,门诊慢病支付方式下患者的门诊总费用和补偿比例均显著高于门诊普通,而门诊统筹支付下患者的门诊总费用低于门诊普通,但补偿比例高于门诊普通。另外,不同年龄段、性别、收入、职业和疾病人群对门诊费用和补偿比例的影响存在差异。结论:应优化医保门诊补偿,平衡各种医保统筹制度,提高不同人群医保补偿的公平性。Objective:To describe the outpatient pooling funds of medical insurance in a city,to analyze the influence of outpatient pooling funds on outpatient expenses of cancer patients,to discuss and put forward suggestions.Methods:Statistical methods were used to describe the social demographic characteristics of cancer patients in a city,and outpatient expenses with different pooling funds mode.Logistics regression was used to analyze the influence factors of the outpatient expenses of cancer.Results:The results of descriptive statistical analysis showed that the proportion of outpatient visits(37.97%)and the total annual outpatient cost(959.47 yuan/per year)of breast cancer patients were higher than those of the other four types of cancer.The total outpatient visit cost of liver cancer patients was the highest(76.79 yuan/per visit).There were differences in the proportion of medical insurance outpatient co-ordination for the five types of cancer,with the highest percentage of compensation for gastric cancer.Multivariate regression results showed that the total outpatient cost and compensation rate of patients under the outpatient chronic disease payment method were significantly higher than that of the outpatient clinic,and the total outpatient cost of the outpatient clinic under the overall payment was lower than the outpatient clinic,but the compensation rate was indeed higher than the outpatient clinic.In addition,different age groups,genders,incomes,occupations and diseases had different effects on outpatient expenses and compensation rates.Conclusion:The government should optimize the outpatient compensation system of medical insurance,balance the various pooling funds,and improve the equity of reimbursement of medical insurances.

关 键 词：门诊统筹 门诊费用 癌症 

分 类 号：R197.1[医药卫生—卫生事业管理]