某欠发达地区大病保险保障效果及其影响因素  

Security Effect and Influencing Factors of Critical Illness Insurance in the Underdeveloped Area

作　　者：胡杨木 李璐[1] 杜灵 范阳东[1] HU Yangmu(School of Health Management,Guangzhou Medical University,Guangzhou,Guangdong,511436,China)

机构地区：[1]广州医科大学卫生管理学院,广东广州511436 [2]广东金融学院国际教育学院,广东广州510521

出　　处：《医学与社会》2024年第12期117-123,共7页Medicine and Society

基　　金：国家社会科学基金资助重大项目,编号为17ZDA080;广东省高校基于大数据利用的卫生健康治理哲学社会科学重点实验室项目,编号为2023WSY007;广东省哲学社会科学项目,编号为GD22CYJ27、GD23XGL041;广东省医学科研基金项目,编号为A2024043。

摘　　要：目的:分析欠发达地区某市大病保险的保障效果及其影响因素,为大病保险的政策优化提供参考。方法:获取样本城市医保结算系统2022年大病保险报销数据;采用描述性统计分析不同费用段大病保险的保障效果;采用相关性分析、OLS回归和分位数回归方法分析影响大病保险保障效果的因素。结果:样本城市大病保险平均报销比例为9.70%,且报销比例随着医疗费用的增加呈“U型”变化趋势,在大于20万元的费用区间大病保险报销比例达到极大值(15.62%),在2-5万元的费用区间保险报销比例最低(9.08%);OLS分析表明基本医疗保险支付金额、自付金额、年龄、是否异地就医、住院天数和就诊次数对大病保险保障效果有显著的正向作用;分位数回归分析表明,大病保险保障效果的影响因素在不同费用段存在差异。结论:样本城市大病保险的保障效果有限,降低大病保险起付线、扩大大病保险报销范围、逐步取消大病保险封顶线能够提升大病保险保障效果。Objective:To analyze the security effect and influencing factors of critical illness insurance in the underdeveloped area,so as to provide reference for the policy optimization of critical illness insurance.Methods:The reimbursement data of critical illness insurance in 2022 of the medical insurance system in the sample city were obtained.Descriptive statistics were used to analyze the protection effect of critical illness insurance in different cost segments.Correlation analysis,OLS regression and quantile regression were used to analyze the influencing factors affecting the coverage of critical illness insurance.Results:The average reimbursement ratio of critical illness insurance in the sample city was 9.70%,and the reimbursement ratio showed a"U-shaped"trend with the increase of medical expenses,with the reimbursement ratio of critical illness insurance reaching the maximum value(15.62%)in the cost range of more than 200000 yuan,and the lowest insurance reimbursement ratio(9.08%)in the cost range of 20000-50000 yuan.OLS analysis showed that the amount of basic medical insurance payment,out-of-pocket amount,age,cross-region treatment,length of hospital stay and the number of visits had a significant positive effect on the security effect of critical illness insurance.Quantile regression analysis showed that the influencing factors of the coverage of critical illness insurance were different in different cost segments.Conclusion:The security effect of critical illness insurance is limited,and it can be improved by lowering the threshold of critical illness insurance in the sample city,expanding the reimbursement scope of critical illness insurance,and gradually abolishing the ceiling of critical illness insurance.

关 键 词：大病保险 保障效果 影响因素 欠发达地区 

分 类 号：R-05[医药卫生] R197.1