北京市新农合大病保险实施效果分析与评价

Analysis and evaluation of the implementation effect on catastrophic disease insurance of the New Rural Cooperative Medical Scheme in Beijing

目的：测算分析北京市新农合大病保险对患者疾病经济负担的减轻作用,对制度实施效果进行评价。方法：按照经济发展水平和大病保险承办方式选取北京市三个区县,再从中选择大病患者较多的2~3个乡镇。通过与大病保险管理者进行访谈,了解其运行现状;对样本乡镇全部大病患者进行问卷调查了解患者主观感受,收到有效问卷497份。利用新农合管理中心信息平台测算患者疾病经济负担。对定量和定性资料分别采用统计分析与主题框架法进行分析。结果：经大病保险报销,三个区县大病患者平均自付费用明显减轻,实际补偿比均有不同程度的提高,但灾难性卫生支出情况无显著改善。结论：应通过提高大病保险起付线与报销比例,拓宽报销目录等举措提高其补偿水平,重点缓解极重患者疾病经济负担。

Objective： To analyze the effects of the catastrophic disease insurance of New Rural Cooperative Medical Scheme（ NRCMS） on alleviating the economic burden of patients in Beijing,and evaluate the effect of the policy implementation. Methods： Based on high,middle and low economic development levels and the implementation proceedings of catastrophic disease insurance of NRCMS,this paper selects 3 districts of Beijing,from which it chooses two or three villages and towns with the highest numbers of catastrophic disease patients,in order to understand the operational status quo of the catastrophic disease insurance through in-depth interviews with managers. This paper conducts questionnaire survey among all catastrophic disease patients from the sampled villages and towns,and uses 497 valid questionnaires received to understand patients＇ subjective feelings and collect relevant data of family income and medical expenditure of catastrophic disease patients in 2013. Then it carries out data docking with the platform of NRCMS management centers and measure the economic burden of catastrophic disease patients. In this paper,quantitative and qualitative data are analyzed using statistical and thematic analyses,respectively. Results： The catastrophic disease insurance of NRCMS has significantly played an important role in reducing the average medical expenditure of catastrophic disease patients and improving the actual compensation ratio in varying degrees. However,the incidence of catastrophic health expenditures has not significantly improved. Conclusion： This paper suggests to increase deductibles and reimbursement ratios of catastrophic disease insurance in order to broaden reimbursement directory and other initiatives to improve the compensation level and focus on alleviating the economic burden of catastrophic disease patients.