| 引用本文：贾莉英,孟庆跃,袁蓓蓓,等.关于成本分摊政策变化对参保者影响的系统综述[J].中国卫生政策研究,2012,5(8):56-61 |
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| 关于成本分摊政策变化对参保者影响的系统综述 |
| 投稿时间：2012-05-03 修订日期：2012-06-23 PDF全文浏览 HTML全文浏览 |
| 贾莉英1, 孟庆跃1, 袁蓓蓓1, 杨冰一1, 张国杰1, 赵世超1, 常捷1, 于海宁1 |
| 山东大学卫生管理与政策研究中心卫生部卫生经济与政策研究重点实验室 |
| 摘要:目的：分析成本分摊政策变化对参保者的影响，为我国医疗保障制度改革提供科学证据。方法：利用系统综述方法，检索国内外所有对医疗保险制度实施成本分摊政策的相关研究，由系统综述人员对这些研究进行筛选和数据提取，利用框架分析法对纳入研究进行整合。结果：纳入48篇文献，共付额度、共付保险率、起付线和封顶线以及综合成本分摊方法对不同类型健康保障制度下，不同参保者卫生服务、药物利用以及经济负担的影响不同。结论与建议：成本分摊政策是控制医疗费用的手段；不同医疗保险制度下成本分摊政策对参保者卫生服务利用的影响存在差异；不同类型的卫生服务对成本分摊政策敏感程度不同。我国可以利用成本分摊机制控制医疗总费用，但要考虑其对不同经济状况参保者的影响以及对不同卫生服务的价格弹性，同时关注弱势群体的卫生服务需求。 |
| 关键词:系统综述 成本分摊 医疗保险 |
| 基金项目:世界卫生组织卫生政策与系统研究联盟项目（CSR11） |
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| The effect of the changes of cost sharing policy on the insured: A systematic review |
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| Abstract:Objective: To put forward evidence on how to change cost sharing mechanisms for health policy makers. Methods: This is a systematic review, searching all relevant studies about the topic and screened the topics, abstracts and full texts by two authors independently, extracted the key information of the included studies, analyzed the information by theory based framework analysis. Results: Totally 48 articles were included in this review, they were analyzed by different cost sharing methods such as copayment, coinsurance, deductible and ceiling and mixed methods. The included studies showed that the effects of cost sharing policies were different for the enrollees in different health insurance schemes in terms of different health services utilization, drugs use and financial risks. Conclusion and suggestion: Cost sharing mechanisms can be taken as one instrument to control medical expenditure, but the effects are different in different health insurance schemes, the price elasticity is different between health services. We should make use of cost sharing mechanisms to control medical expenditure, but the financial risks of the enrollees and the price elasticity of different health services should be considered. The medical demand of vulnerable population should be satisfied. |
| Key words:Systematic review Cost sharing Health insurance |
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