上海市困难对象医疗费用负担与救助效果研究

Analysis on the Health Costs of the Medical Aid Objects and the Effect of Medical Aid in Shanghai

目的:测算2015—2017年上海市困难对象(包括城乡低保、城乡低收入、特殊救济、支出型贫困以及重残无业对象)医疗费用负担,分析医疗救助实施效果。方法:通过民政局医疗救助数据库采集上海市2015—2017年困难对象人员信息,通过医保部门数据库采集困难对医疗费用信息,采用自付医疗费用、灾难性医疗支出发生情况评价其医疗费用负担,运用STATA 13.0开展数据分析。结果:2015—2017年上海市困难对象人数逐年递减,下降幅度在5%~8%之间。2017年,困难对象人均医疗费用为12434.26元,人均自付费用4131.94元(占比33.23%),人均自费费用为958.31元(占比7.71%)。经医疗救助后,自付比例下降13.70个百分点达到19.53%,灾难性医疗支出的发生率下降4.87个百分点达到5.86%。结论:部分困难对象医疗费用负担较重,但医疗救助效果显著,报销流程得到优化。建议扩大救助范围,实现精准扶贫,完善"一站式"服务系统,促进医疗救助资金有效监管,同时鼓励社会参与。

Objective:To estimate the health costs of medical aid objects in Shanghai(including residents receiving subsistence allowance,low-income resident,special relief population,impoverished households,and severely disabled population) from 2015 to2017,and analyze the effect of medical aid.Methods:2015-2017 Basic information of the medical aid objects are collected from the Medical Aid Database of the Civil Affairs Bureau.Data on their medical expenses are retrieved from the database of the medical insurance department.Indicators including out-of-pocket medical expenses and catastrophic medical expenses are used to assess the health costs burden.Results:The number of medical aid objects in Shanghai decreased by years from 2015 to 2017,with a increasing rate ranged from 5% to 8%.In 2017,the per capita medical expenses of the medical aid objects were 12 434.26 yuan,the per capita out-of-pocket expenses were 413.94 yuan(33.23%),and the per-capita expenses out of the range of medical insurance coverage were 958.31 yuan(7.71%).After medical aid,the out-of-pocket ratio(13.70%) decreased to 19.53%,and the incidence of catastrophic medical expenditures(4.87%) decreased to 5.86%.Conclusion:The medical aid system in Shanghai is effective in releasing the health cost burden of the medical aid objects,and the reimbursement process has been optimized.It is recommended to expand the scope of assistance to achieve precise poverty alleviation.The "one-stop" service of medical aid needs to be improved to promote effective supervision of the medical aid funds,and social participation needs to be encouraged.