我国333个地级市慢性乙型肝炎医保报销及对策调查

Current status of medical reimbursement for chronic hepatitis B and related countermeasures: an investigation in 333 prefecture-level cities

通过对全国333个地级市的城镇职工医保和城镇居民医保的门诊特殊慢性病政策的调研,发现78%的地级市的城镇职工医保和57%的地级市的城镇居民医保已将慢性乙型肝炎纳入门诊医保报销范围。但是存在慢性乙型肝炎相关病种诊断表述不统一、鉴定标准不一、报销程序不规范、侵犯患者隐私、门诊慢性病一次开药量偏少等问题。为此,建议由国家人力资源和社会保障部出台统一政策,将慢性乙型肝炎纳入门诊医保报销范围,统一疾病诊断名称和鉴定标准,规范慢性乙型肝炎的报销程序并适当增加开药量等。

An investigation of the special policies for chronic diseases in medical insurance for urban employees and residents has been conducted in 333 prefecture-level cities in China,and the results showed that 78% of all cities included chronic hepatitis B（ CHB） in medical reimbursement for urban employees and 57% included CHB in medical reimbursement for urban residents. However,there are still some issues to be resolved,such as inconsistent descriptions of the diagnosis of CHB-related diseases,inconsistent diagnostic criteria,lack of standardization of reimbursement process,infringement of patient privacy,and inadequate dose prescribed for CHB patients in the outpatient service. Therefore,we suggested that the Ministry of Human Resources and Social Security should introduce unified policies to include CHB in medical reimbursement,unify disease name and diagnostic criteria,standardize the reimbursement process for CHB,and increase the prescribed dose.