江苏省城镇基本医疗保险补偿水平评价

Evaluating the Compensation Level of Urban Basic Medical Insurance in Jiangsu

目的:对江苏省城镇职工、居民基本医疗保险补偿水平进行评价。方法:以灾难性卫生支出设定基本医疗保险的底线补偿比例,以参保人群住院费用实际受益情况设定实际补偿比例,以四分位法比较分析各统筹市底线补偿比例与实际补偿比例的差值。结果:以10%作为灾难性卫生支出的临界值,职工医保的补偿水平高于底线水平,居民医保的补偿水平则低于底线水平。结论:职工医保的补偿水平一定程度上缓解了参保人群因病致贫的经济压力,而居民医保的补偿水平有限,尚待进一步提高。

Objective： To evaluate the compensation level of the Urban Employee Basic Medical Insurance（UEBMI） and Urban Resident Basic Medical Insurance（URBMI） in Jiangsu province. Methods： Take catastrophic health expense as the bottom line of compensation ratio for the basic medical insurance, the benefit of hospitalization expenses of those joining the insurance as the actual line of compensation ratio, and quartile division was used to comparatively analyze the differences between the bottom line of compensation ratio and the actual line of compensation ratio. Results： Take 10% as the critical value of catastrophic health expense, the actual line of compensation level is higher than the bottom line of compensation level in UEBMI, and there is reverse in URBMI. Conclusion： In some extent, the compensation level of UEBMI has relieved the economic burden of the poor jointed group because of sickness, while limited compensation level of UEBMI is in need of further improvement.