江西省2014年结核病新型农村合作医疗保险情况调查分析

The survey analysis of tuberculosis new rural cooperative medical insurance in Jiangxi Province in 2014

目的了解江西省结核病新型农村合作医疗保险情况,为卫生部门制订结核病防治策略提供依据。方法对2014年江西11个设区市所辖的100个行政县区进行结核病新型农村合作医疗保险状况调查。结果关于结核病的江西省新型农村合作医疗保险门诊和住院报销起始线较低,封顶线较高,有一定的报销比例,所有县区结核病住院均能实行新农合报销,对县结防机构门诊结核病报销的县区覆盖率为89.7%,对县医院门诊结核病报销的县区覆盖率仅59.8%。结论江西省目前的结核病新型农村合作医疗保险制度能基本满足农村肺结核患者的就诊需要。但当前结核病面临不少新的挑战,如HIV/AIDS结核患者、耐多药、流动人口的肺结核患者的门诊费用较高,因门诊结核患者只能报销大部分费用,此部分农村结核病患者将带来不少费用缺口,加上调查显示全省仍有近10%的县结防机构门诊不能报销结核病,二者需引起重视和得到改善。

Objective To reveal TB new rural cooperative medical insurance（NCMS） of Jiangxi Province and provide the basis for the development of TB control strategy in the future. Methods The 11 municipalities and their administrative 100 counties in Jiangxi were investigated under TB NCMS in 2014. Results Low reimbursement starting line,high sealed item line and a certain percentage of reimbursement were practiced among TB NCMS In Jiangxi province. TB patients expense in hospitals among all counties were in NCMS reimbursement; county TB institutions outpatient tuberculosis reimbursement coverage was 89.7%; county hospital outpatient tuberculosis reimbursement coverage was 59.8%.Conclusion The NCMS in Jiangxi province can basically meet the needs of rural tuberculosis patients. But the current TB control work is facing many new challenges. Patients suffering from HIV/AIDS tuberculosis, multi drug resistance,floating population of tuberculosis patients with higher outpatient costs, and outpatient tuberculosis patients can only be reimbursed for most of the cost, so these rural TB patients will bring a lot of cost gap. At the same time this survey shows that in Jiangxi province nearly 10% of county＇s TB institutions couldn＇t be reimbursed for tuberculosis in outpatient service, so these two factors need to pay attention to and be improved.