浙江省城乡居民医保门诊慢特病待遇保障现况及政策差异分析  

Analysis on Current Status and Differences of Medical Insurance Policy for Chronic and Special Diseases in Medical Insurance Outpatients for Urban and Rural Residents in Zhejiang Province

作　　者：范晓苑 刘凯捷 楼英婷 高奇隆 董恒进 

机构地区：[1]浙江大学公共卫生学院,杭州310058 [2]浙江省人民医院,杭州310014

出　　处：《中国医疗保险》2023年第7期85-90,共6页China Health Insurance

基　　金：浙江省医疗保障研究会课题研究项目“浙江省门诊用药一体化保障机制的研究”(zjybkt-202102)。

摘　　要：目的:分析浙江省各医保统筹区城乡居民医保的门慢、门特病种政策差异,为进一步完善门诊慢特病保障制度提供参考。方法:收集并梳理浙江省11个医保统筹区城乡居民医保门慢、门特病种相关的医保政策,从病种目录、报销水平、备案及报销模式等角度进行比较分析。结论:研究发现,当前浙江省慢特病种区域间政策差异明显,造成区域间的公平性差异,增加了医保统筹管理的难度。建议:建立完善全省统一的门诊慢特病种目录;确定公平合理的门诊慢特病种报销待遇水平,缩小区域间差距;优化门诊慢特病种备案与报销流程;做好新旧政策衔接工作,加强政策宣传。Objective:The paper analyses the policy differences between outpatient chronic and special diseases in Zhejiang Province to provide a reference for the improvement of the medical insurance system for chronic and special diseases.Methods:This study collects the medical insurance policies related to outpatient chronic and special disease in 11 pooling areas in Zhejiang Province.This paper analyzes the policies of medical insurance between different cities from the perspective of catalogue of diseases,reimbursement amount,filing and reimbursement modes.Conclusion:The results show that the current policy on chronic and special diseases in Zhejiang Province was obviously different between regions,which affects the fairness of medical insurance and causes difficulties of medical insurance integration and management.Suggestions:We should establish and update the unified catalogue of chronic and special diseases,explore the fair and reasonable reimbursement for chronic and special diseases to narrow the gap between regions,optimize the process of filing and reimbursement for outpatient chronic and special diseases,ensure the coherence between policies and enhance the policy promotion.

关 键 词：城乡居民医保 医保待遇 门诊慢性病种 门诊特殊病种 卫生政策 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]