全民健康覆盖视角下农村贫困人群医疗服务需求和医疗救助研究

Research on Medical Service Demand and Medical Assistance of Rural Poverty-stricken Population from the Perspective of Universal Health Coverage(UHC)

目的:分析农村贫困人群住院服务需求和救助现状,为完善医疗救助政策提供参考。方法:利用湖北省A地2014-2016年新农合和医疗救助补偿数据库,从全民健康覆盖(Universal Health Coverage,UHC)评价维度中的服务覆盖和费用覆盖两方面对农村贫困人群的住院服务需求和救助水平进行分析。结果:农村贫困人群2016年医保目录外费用占自付费用比例为64.22%,远高于全人群(35.91%)。农村贫困人群中县外就诊的患者自付费用比例为42.83%,高于县内(14.08%)。疾病诊断方面,贫困患者以恶性肿瘤等重大疾病为主。建议:针对贫困人群拓宽医疗救助目录;提高自付费用较高患者医疗救助比例;促进贫困人群医疗救助县外就诊直接结算。

Objective:To analyze the demands of inpatient services and the status of medical assistance for the rural poverty-stricken population,and to provide references for improving the medical assistance policy. Methods:Using the 2014-2016 New Rural Cooperative Medical System and Medical Assistance Compensation Database of a county in Hubei,the hospitalization service demand and the level of assistance for rural poor from the service coverage and cost coverage in the Universal Health Coverage (UHC) evaluation dimension were analyzed. Results:The proportion of costs out of benefit package over out-of-pocket (OOP) expenses for rural poor people was 64.22% in 2016,which was much higher than the whole population (35.91%).The proportion of OOP of out-ofcounty patients was 42.83%,which was higher than that in the county (14.08%).In the diagnosis of diseases,poor patients are mainly caused by malignant tumors and other critical diseases.Advice:Expand the medical assistance catalogue for the poor,improve the proportion of medical assistance for high OOP patients,and promoting direct settlement of medical assistance for poor people receiving medical treatment outside county.