中国农村居民重大疾病保障制度评价指标体系构建及运行效果分析——以东中西部101个医保统筹地区为例

An Analysis on the Construction of Evaluation Index System of Catastrophic Disease Insurance for Rural Residents in China and the Evaluation of Its Implementation Effect: A Case Study of 101 Medical Insurance Co-ordination Areas in Eastern,Central and West

本研究选择了东中西部6个省份的101个医保统筹地区,研究我国农村居民重大疾病保障制度的运行效果。基于德尔菲法和层次分析法建立了农村居民重大疾病保障制度评价指标体系,包括人口覆盖指标、筹资指标、基金支出指标、大病保障补偿指标和大病患者医疗费用指标,共分为5个一级指标,21个二级指标。采用层次分析法确定每个指标的权重,并对江苏、福建、安徽、湖南、内蒙古、四川农村居民重大疾病保障制度运行情况进行了评价。研究结果表明,筹资指标和大病保障补偿指标是影响农村居民重大疾病保障制度运行的两个特别关键因素,东中部地区的农村居民重大疾病保障制度的整体运行水平要高于西部地区。本研究为进一步完善农村居民重大疾病保障制度提供了相关实证依据。

In this study,101 integrated areas in six provinces in the eastern,central and western regions were selected to study the effect of rural residents'catastrophic disease insurance.Based on the Delphi method and the analytic hierarchy process,the evaluation index system of the effect of the rural residents'catastrophic diseases insurance was established,including the population coverage index,the fund raising index,the fund expenditure index,the compensation index of the serious illness insurance and the medical expenses of the patients with catastrophic disease.It consisted of 5 first-level indicators and 21 secondary indicators.AHP method was used to determine the weight of each index,and the effect of the catastrophic diseases insurance of rural residents in Jiangsu,Fujian,Anhui,Hunan,Inner Mongolia and Sichuan P rovinces was evaluated.The results showed that the financing and compensation of serious illness insurance were two especial key factors influencing the effect of rural residents'catastrophic disease insurance,and the overall performance of rural residents'catastrophic disease insurance in the eastern and central regions was higher than that in the western region.This study provided relevant empirical evidence for improving the implementation of the system of catastrophic diseases of rural residents.