从高校学生角度探讨大学生医保运行的实施效果

An Exploration of the Implementation of the Medical Insurance from the Perspective of College Students

目的了解大学生纳入城镇居民医疗保险制度以来大学生医保政策的执行效果、存在问题与解决对策,以期推进大学生医疗保障体系不断完善。方法对济南市5所高校4 620名在校大学生,采用调查问卷与个别访谈方式进行调查,对调查结果进行统计分析。结果对现行大学生医保制度满意和比较满意的学生3 591人（77.73%）,认为没有变化的学生546人（11.82%）,不满意的学生483人（10.45%）。70.74%（3 268人）的学生认为大学生医保在保障学生身体健康、满足学生基本医疗需求方面作用显著和有一定作用,而认为作用不明显或完全没有作用的学生分别为1 090人（23.59%）和262人（5.67%）。77.47%（3 579人）的学生已参保,16.08%（743人）的学生准备参保。对于参加医保的动机,70.33%（3 249人）的学生选择了为获得医疗保障自愿参加,选择因学校要求被动参加的学生为956人（20.69%）,随大流参保的学生415人（8.98%）。大多数学生对自己身体健康状况持乐观态度,认为自己非常健康和健康的学生达3 720人（80.52%）。1个医疗年度内未就诊的学生1 169人（25.30%）,就诊的学生3 451人（74.70%）,其中就诊1~3次的学生2 803人（81.22%）,4~5次的学生522人（15.13%）。在就诊学生中,门诊医疗花费低于100元和101~299元的学生分别为1 010人（29.27%）和1 457人（42.22%）,花费300~599元的学生590人（17.10%）,高于600元的学生394人（11.41%）。在学校医保政策的宣传方面,认为宣传力度大、效果好的学生为1 045人（22.62%）,认为有宣传但效果不明显的学生为2 164人（46.84%）,而认为几乎没有宣传和根本不知道此事的学生分别为1 107人（23.96%）和304人（6.58%）。学生对现行医保政策知道最多的是缴费标准和入保程序,分别为2 882人（62.38%）和2 482人（53.73%）,而对参保待遇和报销程序有所了解的学生较少,仅为1 798人（38.93%）和1 720人（37.23%）。68.27%（3 154人）的学生反映门诊报销程序繁琐,60.78%（2 808人）的学生认为门诊报销比例太低,而认为保险范围窄、住院报销比例低的学生也分别占到了51.47%（2 378人）和38.87%（1 796人）。对大学生医保流程问题反映最多是医保卡发放不及时影响持卡就医（3 730人,80.74%）。学生就诊经常选择的医疗机构主要为校医院（3 374人,73.03%）,而选择校医院就诊的最主要原因是方便、不浪费时间（2 798人,83.05%）,不选择校医院就诊的主要原因为诊疗水平一般（792人,73.06%）。结论济南市的大学生医疗保险制度运行情况良好,通过加大宣传力度、优化报销程序和工作流程、提高校医院服务能力等措施将会吸引更多学生参保并提高大学生对医保政策的认同感和满意度。

Objective To explore the implementation effects, problems and solutions of the medical insurance of college students since they were included in the medical insurance system for urban residents so as to pro- mote the medical insurance system for college students to be perfect. Methods 4 620 college students from 5 colleges and universities in Jinan city were surveyed with questionnaires and individual interviews and the re sults were statistically analyzed. Results 3 591 students （77.73%） were satisfied or very satisfied with the current health care system for college students, 546 students （11.82 %） thought it brought no change into their life, 483 students （10.45%） were dissatisfied. 70.74%（3 268） of students believed the health care insurance for college students played a significant or some role in protecting their physical health and meeting their basic medical needs, and 1 090 students （23.59%） and 262 students （5.67%） thought it played a insignificant or no role. 77.47% （3 579） of students had insured, 16.08% （743） of students were going to insure. For the motiva- tion to insure, 70.33% （3 249） of the students voluntarily chose to insure themselves for the medical insur anee, 956 （20.69%） students chose to buy insurance only because they were required to do it by their school, 415 students （8.98%） followed the general trend to insure themselves. Most college students were optimistic about their physical health and 3 720 students （80.52 % ） considered themselves very healthy or healthy. During one medical year, 1 169 students （25.30%） did not seek medical treatment; 3451 students （74.70%） received medical treatment, among them, 2 803 （81.22%0） had medical treatment once to three times and 522 （15.13%） four to five times. Students who paid outpatient medical cost less than 100 yuan and 101 to 299 yuan were respectively 1 010 （29.27%） and 1 457 （42.22%）, the number of students who spent 300 to 599 yuan was 590 （17.10%） and 394： students （11.41%） spent more than 600 yuan. In terms of the publicity of school health care insurance policy, 1 045 students （22.62%） held that their school made great efforts at its publicity and achieved good effects, but 2 164 （46.84%） believed the effects of its publicity were not significant, and 1 107 （23.96%） thought their school had almost no publicity and 304 （6.58%） did not know about it. For the existing medical insurance policy, students who knew its payment standard and insure procedures were 2 882 （62.38%） and 2 482 （53.73%）, and students who knew insurance treatment and reimbursement procedures were less, only 1 798 （38.93%） and 1 720 （37.23%）. 68.27% （3 154） of students thought the outpatient re- imbursement procedures were tedious and 60.78% （2 808） of students considered the outpatient reimburse- ment ratio was too low. and students who believed that the medical insurance had narrow coverage and hospi- talization reimbursement ratio was low accounted for 51.47% （2 378） and 38.87% （1 796）. For the medical in- surance process, 3 730 （80.74%） students reflected that not-timely issued medical insurance cards would af- fect the cardholders to receive medical treatment. 3 374 （73.03%） students chose their school hospital, 2 798 （83.05 %） selected their school hospital mainly for the convenience and saving their time, and 792 （73.06 %） did not go to their school hospital because the diagnosis and treatment were not good. Conclusion The medical insurance system in Jinan city runs well, and increased publicity, optimized reimbursement procedures and working processes, improving medical service capability of school hospitals and other measures will attract more college students to insure themselves and increase their identity and satisfaction for the medical, insurance policy.