开封市肺结核患者医疗保障现状调查分析

The investigation and analysis of medical insurance status of patients with pulmonary tuberculosis in Kaifeng City

目的了解开封市肺结核患者的医疗保障现状及疾病经济负担,为国家制定落实相关政策提供依据。方法使用统一设计的调查表,随机抽取2009年登记的住院且完成了全部治疗的非耐多药肺结核患者,其中参加新农合、职工医保和居民医保的非耐多药肺结核患者各25人,由调查人员与患者进行面对面或电话随访的方法进行调查。结果开封市新农合、职工医保、居民医保3类医保政策对肺结核患者报销的比例各不相同,其中门诊肺结核患者的医疗费用未纳入报销范围;住院患者的报销比例在60%～80%之间。调查发现,新农合、职工和居民医保肺结核患者实际住院费用报销的比例分别为27.2%、53.7%和50.8%,均低于政策规定的报销比例;报销后医疗费用占患者年非食品支出的比例分别为53.7%、30.6%和32.7%。结论将肺结核病纳入医保,在一定程度上减轻肺结核患者的疾病经济负担,开封市各类医保报销比例各不相同,但肺结核患者实际报销的比例均明显低于政策规定的报销比例;其中新农合肺结核病患者的疾病经济负担尤其较重。

Objective To understand the medical insurance status and economic burden of patients with pulmonary tuberculosis in Kaifeng City and provide evidence base for formulation of relevant policies. Methods This study used a unified questionnaire.Non-MDR-TB patients who registered in 2009 and have completed treatment were eligible for enrollment.Twenty-five eligible patients in each insurance category including the new cooperative medical system,medical insurance for urban workers,and residents insurance were randomly selected respectively.Investigations were made through face-to-face and telephone interview. Results The reimbursement policies on the proportion of TB patients varied between three types of health insurance.The medical expenses of out-patient pulmonary tuberculosis patients were not included in the scope of reimbursement.The reimbursement for patients living in hospital was between 60%-80%.The survey also found that the actual reimbursement proportion of hospitalization expenses for the new cooperative medical system,medical insurance for urban workers,and residents insurance were 27.2%,53.7% and 50.8% respectively,lower than the reimbursement policies and regulations;Medical expenses excluding the reimbursement accounted for 53.7%,30.6% and 32.7% respectively in non-food expenditure. Conclusions Including pulmonary tuberculosis in the health insurance could reduce the economic burden to a certain extent.However,the reimbursement policies varied between different types of insurance.The actual reimbursement were significantly lower than the reimbursement policies and regulations,The economic burden of new rural cooperative system TB patients is still relatively heavy.