福建省新农合住院患者大病医保现状及对策研究

Research on current situation and countermeasures of medical insurance for serious diseases of inpatients under NCMS in Fujian

目的对福建省2014-2016年新农合住院数据进行分析,为完善福建省大病医保政策提供可行性建议,以期减轻居民医疗经济负担,降低因病致贫、返贫现象的发生。方法对相关文献、政策进行收集分析,用Excel进行分类汇总,对福建省新农合住院患者大病医保现状进行分析。结果 2014-2016年,福建省新农合住院患者大病补偿人次和补偿总额逐年上升,补偿共计41.18万人次和8.48亿元,但人均补偿额由2014年的2 278.5元降至2016年的1924.7元。全省的平均补偿比由2015年为41.29%上升至2016年的43.84%,住院费用不断增加,特别是20万元以上的高额医疗费用占比逐年增高,且自付比接近三分之二,患者的医疗经济负担仍较重。福建省各地市的新农合大病医保政策不统一,保障对象不明确,个人医疗经济负担仍较高,还存在因病致贫等问题。结论目前,福建省的大病医保政策未能完全解决"因病致贫、因病返贫"现象,建议完善大病医保筹资机制,进一步明确保障对象,降低个人支付比例,探索个人自付封顶模式,扩大病种、药品保障范围,提高信息化建设和服务水平等。

Objective To analyze the data of NCMS in Fujian between 2014 and 2016,provide feasible suggestions for improving the serious illness insurance policy in Fujian,so as to reduce the medical burden of residents and reduce poverty due to diseases.Methods Relevant literatures and policies were collected and analyzed.The data was classified and summarized by Excel,and then the tables and figures were made to analyze the current situation of the major medical insurance.Results From 2014 to 2016,the number and the total amount of serious diseases compensation in Fujian increased year by year,compensation totaled 411 800 person-times and 848 million yuan,but the per capita compensation reduced from 2278.5 yuan in 2014 to 1924.7 yuan in 2016.The province’s average compensation ratio had increased slightly(41.29% in 2015 to 43.84% in 2016),but hospitalization expenses had been rising,especially the proportion of high medical expenses of more than 200 000 yuan had increased year by year,and patients needed to pay nearly two-thirds of the medical expenses,the medical economic burden was still heavier.The NCMS in Fujian was currently not unified yet,how to define the poor was not clear,the personal medical economic burden was still high,and there was still poverty due to diseases.Conclusion At present,the policy of serious diseases insurance in Fujian has not completely solved the phenomenon of "poverty due to diseases and return to poverty due to diseases".It is important to improve the financing mechanism for major diseases medical insurance,further clarify the object group of poor,reduce the proportion of personal payment,explore personal self-payment capping mode,expand the scope of reimbursable diseases and drugs,improve the information construction and service quality.