江西省结核病医疗保险基本情况调查分析

The Survey Analysis of the Basic Situation of Tuberculosis Medical Insurance in Jiangxi Province

目的了解江西省结核病医疗保险基本情况,为卫生部门今后制订结核病防治策略提供依据。方法对2012年江西省11个设区市所辖的100个行政县、区进行结核病医疗保险状况调查。结果江西省城镇职工医疗保险、城镇居民医疗保险和新型农村合作医疗3种保险门诊和住院报销起付线较低,封项线较高,3种保险住院大部分县、区(94.0%以上)均实行了医保,门诊3种保险分别有49.0%、49.0%和10.0%的县、区未实行医保。结论江西省目前的结核病医疗保险覆盖面基本能满足患者的就诊需要,但城镇人群结核病门诊医保覆盖欠佳,加上结核病面临三大新挑战,耐多药、流动人口和患HIV/AIDS的结核病人门诊费用较高,此部分城镇病人将带来较大的费用缺口,需要引起重视。

OBJECTIVE To reveal TB medical insurance of Jiangxi Province and provide the basis for the health sector in the development of TB control strategy in the future. METHODS 11 municipalities and their administrative 100 counties were investigated under TB medical insurance. RESULTS In Jiangxi Province, low reimbursement starting line and high sealed item line were practised among urban workers medical insurance, medical insurance for urban residents, the new rural cooperative medical insurance. Most（Over 94.0%）of the counties in the 3 insurance have implemented medical insurance for inpatient. For outpient among the above three kinds of insurance respectively 49.0%, 49.0% and 10.0% of the counties not implemented the medicare. CONCLUSION Jiangxi Provincal TB medical insurance system can basically meet the treatment needs of TB patients. But the urban population TB out-patient medicare coverage status is poor. TB is facing three major challenges, and TB patients need high outpient costs because of MDR, floating population and the suffering of HIV / AIDS. This part of town patients will bring the cost gap which needs attention.