杭州与宝鸡两地不同医疗保险参保者医疗费用分析

Medical expenditure analysis of different medical insurances in Hangzhou and Baoji

目的 :评价杭州与宝鸡两地城镇职工、城镇居民基本医疗保险的保障水平。方法 :制定家庭健康调查表,采用多阶段分层随机抽样进行入户调查。结果 :宝鸡市居民的门诊就诊自付比例高于杭州,杭州市居民住院次均费用高于宝鸡。两地城镇职工参保者门诊、住院次均费用自付比例均高于城镇居民参保者。结论 :居民医疗费用负担整体有所减轻,但不同经济水平地区间、不同基本医疗保险制度的医疗保障水平存在一定差距,应通过完善筹资机制、适当提高基本医疗保险的保障水平来缩小差距。

Objective：To evaluate the security level of Urban Employees’ Basic Medical Insurance （UEBMI）and Urban Residents’ Basic Medical Insurance（URBMI）in Hangzhou and Baoji. Methods：Family health questionnaire was designed and multistage stratified random sampling was conducted in the household surveys. Results：Out-of-pocket（OOP）proportion of outpatient visit is higher in Baoji. The average expenditure per hospitalization is higher in Hangzhou. OOP proportions of outpatient visit and hospitalization were significantly higher for URBMI enrollees than UEBMI enrollees in both cities. Conclusion：Overall,the medical expense burden was reduced. Gaps existed between different regions and health insurance systems,which was suggested to be reduced by improving financing mechanism and raising the security level.