城乡居民五部位癌症医疗保障水平与效果:以安徽某地为例  

Level and effect of medical insurance for five parts of cancer for urban and rural residents:a case study in Anhui Province

作　　者：蒋加诚 胡璐 陈柱 陈思璇 金心钰 王丽丹[1,2] JIANG Jia-cheng;HU Lu;CHEN Zhu;CHEN Si-xuan;JIN Xin-yu;WANG Li-dan(School of Health Management,Anhui Medical University,Hefei,Anhui 230032,China;不详)

机构地区：[1]安徽医科大学卫生管理学院,安徽合肥230032 [2]安徽医科大学卫生政策研究中心

出　　处：《现代预防医学》2024年第20期3736-3740,共5页Modern Preventive Medicine

基　　金：安徽医科大学医院管理研究所‘国医科技’开放项目(2022gykj01);公共健康社会治理安徽省哲学社会科学重点实验室项目(PHG202310);安徽省自然科学基金项目(2308085MG236)。

摘　　要：目的以安徽某地为例观察我国五部位癌症的医疗保障水平及效果。方法使用该地2019—2021年三年间的医保结算清单数据,借鉴实际补偿比、底线补偿比和灾难性卫生支出的概念分医保体系层次、分费用段、分医疗机构级别等计算医疗保障水平与效果。结果总体上患者自付占比维持在30%左右;高额医疗费用患者自付占比较小(16.59%);三级医疗机构实际补偿比较低(65.81%~70.52%),但总体上依然超过了40%和25%灾难性卫生支出标准下的底线补偿比。结论多层次医保体系初见成效。需要均衡不同癌种的保障水平,进一步强化分级诊疗,关注“大病小治”患者的需求。Objective To observe the level and effect of medical insurance for five sites of cancer in China using an area of Anhui Province as an example.MethodsUsing the district’s Medicare billing list data for the three-year period 2019-2021.Based on the concepts of actual compensation ratio,bottom-line compensation ratio and catastrophic health expenditure,the level and effect of medical security were calculated by level,cost and level of medical institution,etc.Results Overall,the out-of-pocket share of the patients was maintained at around 30%,the out-of-pocket share of patients with high medical expenses was small(16.59%).The level of tertiary medical institutions’actual compensation ratio was low(65.81%-70.52%),but overallit still exceeded the bottom-line compensation ratio under the 40%and 25%catastrophic health expenditure standards.Conclusion The multi-level health insurance system has begun to bear fruit.There is a need to equalize the protection for different types of illnesses,to strengthen the hierarchical diagnosis and treatment,and to pay further attention to the needs of patients with“serious illnesses and light treatment”.

关 键 词：城乡居民 癌症 医疗保障水平 灾难性卫生支出 

分 类 号：R19-0[医药卫生—卫生事业管理]