农村居民视角下城乡居民基本医保制度问题研究

Research on the Problem of Basic Medical Insurance System for Urban and Rural Residents under on the Perspective of Rural Residents

目的:从农村居民的角度了解城乡居民基本医疗保险制度(以下简称城乡医保制度)存在的问题,并给出政策性建议。方法:通过文献分析及小组讨论设计调查问卷,对山东、山西及贵州地区的1 020位农村居民采用面对面调查的方法,让农村居民对各问题的严重程度进行1~5分打分并按照问题的严重程度进行由高到低的顺序排序,在此基础上用因子分析进行聚类分析。结果:城乡医保制度的问题排在前三位的分别是报销覆盖的内容少;起付线高;封顶线低。通过因子分析,共提取出4个公因子,分别为保障制度因子、监督管理因子、医保制度反应性因子和保障效果因子。结论:从农民的角度看,报销覆盖的内容少是城乡医保制度最为严重的问题,为了进一步完善城乡医保制度的缺陷,让城乡医保制度在减低疾病经济负担上发挥更大的作用,重点应从保障制度因子入手,尤其要扩大城乡医保制度的报销目录。此外,要从加强对三方的监督管理机制、大力宣传医保政策和提高居民满意度等方面来完善城乡医保制度存在的问题。

Objective: To understand the existing problems in the basic medical insurance system for urban and rural residents from the perspective of rural residents, and give policy recommendations. Methods: Through literature analysis and group discussion design questionnaires, 1 020 rural residents in Shandong, Shanxi and Guizhou were investigated by face-to-face survey methods to enable rural residents to score 1-5 on the severity of each problem and follow the problem. The severity was ranked from high to low, and cluster analysis was performed using factor analysis. Results: The problems of the urban and rural medical insurance system ranked in the top 3 were the reimbursement coverage;the deductible line was high;the capping line was low. Through factor analysis, a total of four common factors were extracted, including the safeguard system factor, the supervisory management factor, the medical insurance system response factor and the guarantee effect factor. Conclusion: From the perspective of farmers, the content of reimbursement coverage was the most serious problem of the basic medical insurance system for urban and rural residents. In order to further improve the defects of urban and rural medical insurance system, the urban and rural medical insurance system would play a greater role in reducing the economic burden of disease. It was necessary to start with the safeguard system factor, especially to expand the reimbursement catalogue of the urban and rural medical insurance system. In addition, it must improve the problems in the urban and rural medical insurance system from the aspects of strengthening the supervision and management mechanism for the three parties, vigorously promoting medical insurance policies, and improving residents, satisfaction.