| 引用本文：吴佩林,梁晶,苗艳青,等.城乡居民“两病”门诊用药保障政策设定现状分析[J].中国卫生政策研究,2025,18(2):24-29 |
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| 城乡居民“两病”门诊用药保障政策设定现状分析 |
| 投稿时间：2024-12-10 PDF全文浏览 HTML全文浏览 |
| 吴佩林1,梁晶2,苗艳青3,田东华4 1.北京师范大学政府管理学院北京 100875 2.天津医科大学公共卫生学院北京 300070 3.国家卫生健康委卫生发展研究中心北京 100191 4.北京师范大学社会学院北京 100875 【摘要】目的:分析全国城乡居民“两病”患者的门诊用药保障政策设定现状,为深化“两病”门诊用药保障机制提供参考。方法:采用问卷调查,获取普通门诊统筹、“两病”门诊用药保障机制 |
| 1.北京师范大学政府管理学院 北京 100875 ;2.天津医科大学公共卫生学院 北京 300070 ;3.国家卫生健康委卫生发展研究中心 北京 100191 ;4.北京师范大学社会学院 北京 100875 【摘要】目的:分析全国城乡居民“两病”患者的门诊用药保障政策设定现状,为深化“两病”门诊用药保障机制提供参考。方法:采用问卷调查,获取普通门诊统筹、“两病”门诊用药保障机制 |
| 摘要:目的:分析全国城乡居民“两病”患者的门诊用药保障政策设定现状,为深化“两病”门诊用药保障机制提供参考。方法:采用问卷调查,获取普通门诊统筹、“两病”门诊用药保障机制(“两病”专项)和门诊“慢特病”有关起付线、政策范围内报销比和封顶线的基本情况,并进行描述性统计分析。 结果:在334个统筹区中,同时设定了三项政策的统筹区有253个,占全部统筹区的75.75%。分地区看,普通门诊统筹和“两病”专项的报销比在东中西部间有显著差异(P<0.001),西部明显高于东中部,门诊“慢特病”的报销比在东中西部间没有显著差异(P>0.05)；普通门诊统筹的起付线在东中西部没有显著差异(P>0.05),但“两病”专项和门诊“慢特病”的起付线在东中西部有显著差异(P<0.05),三项政策的封顶线在东中西部间有显著差异(P<0.001)。结论:全国城乡居民“两病”门诊用药保障政策已经实现了应保尽保,但保障水平有待进一步提高,区域间均等化水平有待进一步改善。建议加强数据信息反馈,推进医保省级统筹。 |
| 关键词:高血压 糖尿病 门诊用药保障 政策设定 |
| 基金项目:国家医保局项目(2209444) |
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| Analysis on the current status of outpatient benefit policies for patients with hypertension and diabetes in urban and rural residents |
| WU Pei-lin1, LIANG Jing2, MIAO Yan-qing3, TIAN Dong-hua4 |
| 1.School of Government, Beijing Normal University, Beijing 100875, China ;2.School of Public Health, Tianjin Medical University, Tianjin 300070, China ;3.China National Health Development Research Center, Beijing 100191, China ;4.School of Sociology, Beijing Normal University, Beijing 100875, China |
| Abstract:Objective:To analyze the current policy design of outpatient benefit policies for patients with hypertension and diabetes(H&D) in urban and rural residents in China, and to provide references for optimizing the outpatient benefit mechanism for patients with H&D. Methods:A questionnaire survey was conducted to collect data on the basic features of General Outpatient Benefit (GOB), Outpatient Medication Guarantee Mechanisms for Hypertension and Diabetes (OMGM-H&D) and Outpatient Benefit for Patient with Chronic and Special Diseases (OB-C&S), focusing on deductibles, policy reimbursement ratios, and maximum payment limits. Descriptive statistical analysis was performed on the data. Results:A total of 334 regions were surveyed, of which 253 regions (75.34%) had implemented all three policies. Regional analysis revealed significant differences (P<0.001) in reimbursement ratios for GOB and the OMGM-H&D between the eastern, central, and western regions, with the western region having notably higher ratios than the eastern and central regions. However, no significant difference (P>0.05) was observed in the reimbursement ratios for OB-C&S across regions. Regarding deductibles, no significant regional difference (P>0.05) was found for GOB, but significant differences (P<0.05) existed for the OMGM-H&D and OB-C&S. Additionally, the annual maximum payment limits for all three policies showed significant regional variations (P<0.001). Conclusions:The outpatient benefits policy for patients with H&D have achieved full coverage nationwide among urban and rural residents in China, but regional equity in benefit levels requires improvement. It is recommended to strengthen data feedback mechanisms and promote provincial-level pooling of medical insurance. |
| Key words:Hypertension Diabetes Outpatient benefit Policy design |
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