健康扶贫下重特大疾病医疗救助不同救助方案效果分析

Analysis on Effect of Different Medical Assistance Programs for Critical Illness Patients

目的:基于全民健康覆盖(UHC)视角分析重特大疾病医疗救助不同救助方案实施效果,为进一步优化制度设计提供参考依据。方法:选取湖北省A地和贵州省B地进行机构调查。结果:两地重特大疾病医疗救助政策存在较大差异,A地根据患者合规自付费用划定统一纳入救助标准,B地将因病致贫救助对象界定为患者自付超过家庭前12个月总收入的50%以上。不同救助方案下救助效果差别较大,从覆盖广度上看,A地大病患者救助受益率(26.7%)略高于B地(17.4%);但从覆盖深度和宽度上看,A地人均救助金额和实际救助比均低于B地,救助后贫困线以下患者比例(15.4%)远高于B地(4.5%)。结论:与常规救助对象相比,因病致贫大病患者救助水平有待进一步提高;重特大疾病医疗救助在一定程度上降低了患者自付费用,但大病患者疾病经济负担仍然较重;综合考虑大病患者疾病负担和家庭经济状况,精准认定救助对象,使有限资金发挥更大的作用。

Objective To analyze the effect of different medical assistance programs for critical illness patients and provide reference for further optimizing the program.Methods Selecting City A in Hubei province and City B in Guizhou province for institutional investigation.R esults There were great differences between the two programs.City A set unified standards according to the patient’s reimbursable out-of-pocket payments,and City B defined impoverishment as patient’s reimbursable out-of-pocket payments exceeding 50%of the total income of the previous 12 months of the family.In City A,benefit rate(26.7%)was slight-ly higher than City B(17.4%),but the actual rate of medical assistance was lower than City B.And impoverishment rate in City A(15.4%)is great higher than City B(4.5%).Conclusions:Medical assistance for critical illness reduced patients’out-of-pocket payments,but the economic burden of critical diseases was still heavy.Considering disease burden and family economic situation,we could accurately identify the target and improve the efficiency of limited funds.