基本医疗保险门诊费用实际补偿情况及影响因素分析

Empirical Analysis of the Actual Reimbursement of Basic Medical Insurance of Outpatient Services and Influencing Factors

目的对影响江苏省医保门诊费用补偿的社会经济学因素进行分析,为基本医疗保险制度门诊费用补偿的完善提供政策建议。方法采用描述性分析结合单因素方差分析、广义线性回归模型进行实证分析。结果江苏省医保门诊补偿费用总体平均为171.21元。医保门诊补偿费用与年龄、教育水平、收入、已婚或离异、离退休、参保类型、患一种或多种慢性病显著相关。结论调整优化门诊医疗保险政策,深化门诊统筹,加快分类管理和支付方式改革,完善医疗救助和财政补助,从而提升医保门诊补偿水平。

Objective In order to provide policy recommendations for the improvement of the basic medical insurance system for outpatient services,to analyze the socioeconomic factors that affect the reimbursement of outpatient services expenditure in Jiangsu Province.Methods Descriptive analysis,analysis of variance and generalized linear regression model were applied.Results The overall outpatient services reimbursement cost was 171.21 yuan.Significant correlation between outpatient services reimbursement cost and the influencing factors age,education level,income level,marital status,job status,type of medical insurance and one or more chronic diseases was shown.Conclusion The policy of basic medical insurance for outpatient services should be optimized,the integration of the basic medical insurance for outpatient services be deepened,the reform of the classification management and payment mode be accelerated,and medical assistance and financial subsidies be improved,to improve reimbursement for outpatient services.