五名患者因病致贫的原因分析和对策建议——以常德市大病保险为例

The Analysis of Five Cases of Poverty Due to Illness and Countermeasures ——Critical Disease Issuance in Changde City

2015年度,常德市有五名超过大病保险封顶线的城镇居民参保患者因医疗费用过高,在基本医保和大病保险报销后,其个人负担仍过重,导致家庭因病致贫。本文以常德市人社部门医保中心数据库提供的相关数据为参考依据,在访问五名重特大疾病患者的基础上,通过研究分析这些患者的医疗费用补偿状况、生存和家庭经济状况以及城乡居民大病保险筹资机制和支撑能力等,力图提出制度和运行机制创新思路。建立重特大疾病保障制度,发挥多层次的整体功能,精准施策,才是化解因病致贫风险的可靠之路。

In 2015, there were five urban residents of Changde suffered poverty because of high medical expenditure exceeding the upper limit line of critical illness insurance even after the reimbursement of basic medical insurance and catastrophic disease insurance. With referring to the insurance data of local Human Resources and Social Security department, by interviewing the patients to understand their medical cost compensation, existence and family economic condition, and by studying the funding mechanism and supporting ability of urban and rural residents serious illness insurance, we strive to figure out innovative ideas on system and operating mechanism. The reliable way to reduce the risk of poverty caused by illness is to establish a Special Major Disease Protection System to fully employ the joint function of multi-level insurance and to carry out the policies precisely.