摘要
目的:分析武汉市精神分裂症患者住院医保补偿及不同医保制度下的住院补偿公平性,为完善医保补偿政策以及提升医保公平性提供参考。方法:运用倾向性评分匹配法将武汉市不同医保类型精神分裂症住院患者进行匹配,描述性分析其服务利用及补偿情况。结果:职工医保与居民医保精神分裂症住院患者的实际补偿比分别为77.9%、63.0%;职工医保、居民医保精神分裂症患者流向三级医疗机构的比例分别为75.2%、46.5%;职工医保、居民医保精神分裂症患者政策范围外个人自付占自付费用比例分别为30.8%、14.2%。结论:精神分裂症住院患者疾病负担较重,实际补偿水平仍然不足,患者就医层级较高、医保目录覆盖范围不足降低了精神分裂症住院患者实际补偿水平,不同医保制度下精神分裂症患者住院补偿存在不公平现象;应加大精神分裂症患者住院补偿力度,完善医保目录,引导社区康复,缩小不同医保补偿差距。
Objective:To analyze the inpatient medical insurance compensation and the equity of inpatient compensation under different medical insurance systems for schizophrenia patients in Wuhan,so as to provide references for improving medical insurance compensation policy and improving the fairness of medical insurance.Methods:Schizophrenia inpatients under different medical insurance systems in Wuhan were matched by means of propensity score matching.Descriptive analysis was applied to the utilization and compensation of health services for schizophrenia inpatients under different medical insurance systems.Results:The actual compensation ratio was 77.9% for the inpatients of employees'medical insurance and 63.0% for the inpatients of residents'medical insurance,respectively.The proportion of the inpatients of employees'medical insurance and residents'medical insurance flowing to tertiary medical institutions was 75.2% and 46.5%,respectively.The proportion of out-of-pocket expenses paid by individuals outside the policy scope of patients of employees'medical insurance and residents'medical insurance was 30.8% and 14.2%,respectively.Conclusion:Inpatients with schizophrenia have a relatively heavy disease burden,and the actual compensation level is still insufficient.The higher level of medical institutions where patients seek medical care and the inadequate coverage of the medical insurance catalog limit the actual compensation level for schizophrenia inpatients.The compensation for hospitalization of patients with schizophrenia under different medical insurance systems is unfair.We should strengthen the compensation for hospitalization of patients with schizophrenia,improve the medical insurance catalog,guide community rehabilitation,and narrow the compensation gap between different medical insurance.
作者
刘宵
林坤河
吴文琪
项莉
LIU Xiao(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,430030,China)
出处
《医学与社会》
北大核心
2022年第8期94-99,共6页
Medicine and Society
基金
国家自然科学基金资助项目,编号为71874058。
关键词
基本医疗保险
医保补偿
公平性
精神分裂症
武汉
Basic Medical Insurance
Medical Insurance Compensation
Equity
Schizophrenia
Wuhan
