普惠型商业医疗保险的保障效果研究  

Study on the Protection Effect of Inclusive Commercial Medical Insurance

作　　者：胡杨木 刘敬[2] 钟碧霞 李璐[1] 范阳东[1] HU Yangmu;LIU Jing;ZHONG Bixia;LI Lu;FAN Yangdong(School of Health Management,Guangzhou Medical University,Guangzhou Guangdong 511436,China;不详)

机构地区：[1]广州医科大学卫生管理学院,广东广州511436 [2]广州市第一人民医院,广东广州510180

出　　处：《卫生经济研究》2024年第2期27-30,共4页

基　　金：广东省哲学社会科学规划一般项目“提升基本医保制度公平和效率的策略研究——以广东省为例”(GD22CYJ27);广州医科大学科研提升项目“分级诊疗背景下各级医疗机构医保差异化支付研究”。

摘　　要：目的:分析惠民保对减轻高额医疗费用患者经济负担的作用。方法:采用描述性统计,分析不同层次医疗保险的实际报销情况;利用相关性分析法和多元线性回归方法,分析惠民保对医保目录外费用和封顶线以上费用的保障效果。结果:惠民保对居民医保和职工医保参保患者的平均报销比例为10.85%和8.43%;报销金额与住院天数、超限额金额、丙类项目金额和乙类项目自付金额显著正相关,基本实现了政策目标。建议:完善顶层设计,使多层次医保体系惠及更多参保人;持续推动产品创新,积极向以健康为中心转变;进一步优化报销政策,实现惠民保高质量发展。Objective To analyze the effect of inclusive commercial medical insurance on reducing the financial burden of patients with high medical expenses.Methods The actual reimbursement of different levels of medical insurance was analyzed by the descriptive statistics.The effect of inclusive commercial medical insurance on the protection of expenses outside National Reimbursement Drug List and the expenses above the cap line was analyzed by correlation analysis and multiple linear regression methods.Results The average reimbursement ratios of inclusive commercial medical insurance for resident and employee basic medical insurance participants were 10.85%and 8.43%.The reimbursement amount was significantly and positively correlated with the number of hospitalization days,the amount of over-limit,the amount of category C items and the amount of out-of-pocket payment for category B items,which basically achieved the policy objectives.Conclusion It is necessary to improve the top-level design to enable the multi-level medical insurance system to benefit more insured people,continue to promote product innovation and actively shift to health-centered,and further optimize the reimbursement policy to achieve the high-quality development of inclusive commercial medical insurance.

关 键 词：惠民保 保障效果 多层次医疗保障 

分 类 号：F840.684[经济管理—保险]