基本医疗保险制度下慢性肾病门诊患者保障效果分析

Analysis on the Security Effect of Outpatients with Chronic Kidney Diseases under Basic Medical Insurance

目的:分析武汉市慢性肾病门诊患者的卫生服务利用和医疗费用负担等情况,了解当前基本医疗保险制度下慢性肾病门诊患者的保障效果,提出加强慢性肾病综合管理的发展对策和优化建议。方法:通过问卷调查法对武汉市6家三甲综合医院267名慢性肾病门诊医保患者进行调研,采用专家咨询法对肾脏科医生进行访谈,采用描述性分析方法分析其卫生服务利用、疾病经济风险度、灾难性支出现象、医保满意度等情况。结果:城镇职工医保CKD患者门诊服务利用较为频繁,城镇职工医保类型患者的次均门诊费用高于其他两种医保类型,新型农村合作医疗患者家庭的疾病经济风险度、灾难性支出现象明显高于其他两种医保类型。大部分患者认为当前医保门诊政策不能满足就诊需求。讨论:要加强对新型农村合作医疗医保患者的关注,加强预防教育和早期管理,完善慢性肾病医保门诊管理政策。

Objective： To analyze the health service utilization and burden on medical expenses of outpatients with chronic kidney diseases in Wuhan, to understand the security effects of patients with chronic kidney diseases under the basic medical insurance sys- tem, put forward suggestions to the development strategies and optimizing suggestions on strengthening the comprehensive management of chronic kidney diseases. Methods： Questionnaires were used to investigate 267 CKD outpatients of 6 first-class hospitals in Wu- haM. Expert consultation method was used to interview the kidney doctors. Descriptive analysis method was used to analyze the utiliza- tion of hea]th services, disease economic risk, catastrophic expenditure phenomenon and medicare satisfaction. Results： CKD patients had more frequent utilization of outpatient services, average outpatient expenditures of Urban Employer Medical Insurance outpatients were higher than the others, drug expenditures of New Rural Cooperative Medical System（NCMS） patients were significantly higher than the others. Most patients believed that the current medical outpatient policy could not meet the demand. Conclusion： More atten- tion needed to be paid for NCMS, to strengthen prevention education and early management, improve the management of chronic kid- ney disease outpatient insurance policy.