城镇职工重大疾病医疗保障水平及影响因素研究——基于江苏省的实践调研

Research on the Urban Employees'Major Disease Medical Security Level and Influencing Factors——Based on the Investigation in Jiangsu Province

以江苏省6个样本地区为实证,从病种角度和费用角度对重大疾病的内涵进行了界定。在此基础上,对城镇职工重大疾病医疗保障水平适宜度及保障现状进行了分析,对影响重大疾病保障水平的诸多因素进行了综合研究。结果表明:当前多数地区重大疾病的保障水平与适宜保障水平相比还存在一定的差距,而影响因素主要在于医疗保险偿付政策、医疗总费用、收入水平及社会老龄化等。

This paper takes six areas in Jiangsu province as samples. The definition of the major disease was given out from the aspect of the disease type and the cost. The suitability and the situation of urban employees＇major disease medical secur- ity level were analyzed firstly. And then, the comprehensive study of the influencing factors of major diseases was done. The result shows that the major disease medical security level in most of the regions is still lower than the suitable security level. And the medical insurance compensation policy, total medical cost, income level, and social aging work as the main influ- encing factors.