贵州省肺结核病医疗保障现状调查分析  

Investigation and analysis of the current situation of medical coverage for tuberculosis in Guizhou Province

作　　者：郭雪丽 陈慧娟[2] 李豫[2] 马晓雪 周建 周姣姣 何昱颖 洪峰[1] 李进岚 GUO Xue-li;CHEN Hui-juan;LI Yu;MA Xiao-xue;ZHOU Jian;ZHOU Jiao-jiao;HE Yu-ying;HONG Feng;LI Jin-lan(The Key Laboratory of Environmental Pollution Monitoring and Disease Control,Ministry of Education,School of Public Health,Guizhou Medical University,Guiyang,Guizhou 550025,China)

机构地区：[1]贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵州贵阳550025 [2]贵州省疾病预防控制中心结核病防治研究所,贵州贵阳550004

出　　处：《现代预防医学》2022年第18期3374-3378,共5页Modern Preventive Medicine

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2021-548);贵州省发改委省级基本建设前期工作项目(2020-181-131)。

摘　　要：目的调查贵州省结核病(TB)定点医院肺结核诊疗费用在不同医疗保障政策中的报销情况,为贵州省进一步完善TB医疗保障政策提供依据。方法采用统一设计的调查表,对贵州省97家TB定点医院2020年肺结核诊疗费用在四种不同医疗保障政策中的报销情况进行调查,分析起付线、报销比例、封顶额等。结果全省97家TB定点医院,门诊实施单病种包干政策的比例为38.14%(37/97);在城镇居民基本医疗保险(URBMI)、新型农村合作医疗保险(UCMS)、城乡居民基本医疗保险(城乡居)和城镇职工基本医疗保险(UEBMI)四种医疗保障政策中,门诊报销比例依次为92.86%(26/28)、100%(28/28)、81.16%(56/69)、36.08%(35/97);门诊报销比例中位数依次为50%(P25:50%,P75:57.50%)、55%(P25:50%,P75:100%)、75%(P25:45%,P75:100%)、0(P25:0,P75:72.50%);URBMI、UCMS、城乡居住院报销比例的中位数均为80%(P25:75%,P75:80%),UEBMI为85%(P25:80%,P75:90%)。医疗救助覆盖率为50.56%。结论贵州省目前的医疗保险体系对TB的医疗费用保障水平相对有限,基本医疗保障政策对肺结核门诊诊疗费用报销覆盖面较窄,报销比例和封顶额相对较低,肺结核患者的经济负担仍较重,建议将TB纳入门诊统筹病种,切实提高TB患者医疗保障水平。Objective To investigate the reimbursement of tuberculosis(TB)treatment costs in different medical insurance policies in designated TB hospitals in Guizhou Province,and to provide a basis for further improvement of TB medical insurance policies in Guizhou Province.Methods A unified designed questionnaire was used to investigate the reimbursement data of tuberculosis treatment expenses of 97 designated tuberculosis hospitals in Guizhou Province according to four different medical security policies in 2020,and the starting payment line,reimbursement ratio,and ceiling amount were analyzed.Results Among the 97 designated tuberculosis medical institutions in the province,the proportion of the single-disease contracting policy implemented in outpatient clinics was 38.14%(37/97).Among the four medical security systems of urban residents’basic medical insurance(URBMI),new rural cooperative medical insurance(UCMS),urban and rural residents’basic medical insurance(urban and rural residence)and urban employees’basic medical insurance(UEBMI),the outpatient reimbursement proportion in order were 92.86%(26/28),100%(28/28),81.16%(56/69),and 36.08%(35/97).The median reimbursement rate for the outpatient service was 50%(P25:50%,P75:57.50%),55%(P25:50%,P75:100%),75%(P25:45%,P75:100%),and 0(P25:0,P75:72.50%).The median hospitalization reimbursement rate of URBMI,UCMS and the medical insurance for urban and rural residents was 80%(P25:75%,P75:80%),and UEBMI was 85%(P25:80%,P75:90%).The coverage rate of medical assistance was only 50.56%.Conclusion The current medical insurance system in Guizhou Province has a relatively limited level of coverage for medical expenses of TB,the basic medical insurance policy has a narrow coverage of reimbursement for TB outpatient treatment expenses,and the reimbursement ratio and capped amount are relatively low,leading to heavy financial burden of TB patients.It is recommended that TB be included in the outpatient integrated disease category to effectively improve the level of medical coverage

关 键 词：结核病 医疗保障 保障水平 定点医院 

分 类 号：R19-019[医药卫生—卫生事业管理]