广西城镇居民大病保险实施效果评价:基于第一批试点地区的分析

Effect Evaluation of Critical Illness Insurance for Urban Residents in Guangxi: Based on the Analysis of the First Batch of Pilot Regions

目的:对广西第一批试点城镇居民大病保险的地区进行效果评价。方法:采用文献阅读、政策查阅、定量数据收集方法,收集自试点以来的两年内,即2013—2014年柳州市和钦州市城镇居民大病保险具体政策制定、基金使用情况、大病补偿情况、大病医疗费用等资料和数据,运用Excel和SPSS 18.0对资料进行描述性统计分析及比较分析。结果:大病保险效果显著,2013—2014年柳州市城镇居民大病保险基金利用率分别为118.83%和174.42%,基金结余率分别为-18.83%、-74.42%,实际报销比例分别为61.07%、61.08%。钦州市基金利用率分别为92.83%和76.33%,基金结余率分别为7.17%、23.67%,实际报销比例分别为53.29%、54.81%。结论:大病保险极大地减轻了医保病人大额医疗费用支出负担,有效缓解了"因病致贫,因病返贫"。但大病保险基金压力过大,存在支付赤字问题,大病保险覆盖范围及保障力度也待扩大加强,应逐步探索建立与商业保险机构的合作机制,进一步加强对商业保险机构、医疗机构和医疗费用的监管,健全和完善大病保险政策。

Objective： To evaluate the effects on the first batch of pilot regions of critical illness insurance for urban residents in Guangxi. Methods： Literature review, policy review and quantity data searching method were used to collect data of specific policy design for critical illness insurance, fund usage status, compensation status of critical illness and medical costs for critical illness among urban residents in Liuzhou and Qinzhou since the implementation of pilits from 2013 to 2014. Results： The effects of critical illness insurance was remarkable. The utilization rates of critical illness insurance among urban residents in I,iuzhou in 2013 and 2014 were 118.83% and 174.42%, fund balance rates were-18.83% and-74.42%, the actual reimbursement ratios were 61,07% and 61.08%. Fund utilization rates in Qinzhou were 92.83% and 76.33%, the fund balance rates were 7.17% and 23.67%, the actual reimburse- ment ratios were 53.29% and 54.81%. Conclusion： Critical illness insurance greatly reduced the large medical expenses burden on medicare patients, effectively alleviated the ＂poverty caused by diseases, turned poor due to diseases＂. However, the pressure for criti- cal illness insurance was too heavy and there was deficit problems. The coverage area and safeguard level of critical illness insurance needed to be expanded and enhanced. It needed to gradually explore to establish the negotiation mechanism with connnercial insur- ance institutions, further strengthen the supervision on ommercial insurance institutions, medical institutions and medical costs, im- prove and perfect critical illness insurance policy.