结核病高疫情省份城乡居民耐多药结核病基本医保政策比较

Comparison of medical insurance for multidrug-resistant tuberculosis among urban and rural residents in provinces with high tuberculosis burden

目的比较结核病高疫情省份城乡居民基本医保对耐多药结核病(MDR-TB)保障程度的差别,并为相关政策的完善提供建议。方法根据活动性肺结核发病率纳入研究省份后,从医保补偿方式和标准、补偿效果和提升空间三方面进行省际比较分析。补偿效果用医保补偿前后灾难性卫生支出(CHE)发生率及降幅来衡量,补偿提升空间用人均医保付费占地区人均生产总值比重来评估。结果纳入11个省份中7个省份实施按病种付费,4个省份实施按特殊门诊付费,其中重庆和广西的补偿封顶额均可达10万元/例,新疆住院和门诊补偿比例最高,分别达90%和100%。补偿前,在3.3万元/例的治疗价格标准下,11个省份的城乡居民家庭均会发生CHE;但补偿后,仅有1个省会发生CHE;而当治疗价格标准上升到5万元/例时,补偿后有5个省份的家庭会发生CHE。另外,地区人均医保付费占人均生产总值比重显示各省份当前经济发展水平有进一步提升补偿的空间。结论当治疗费用总额较低时,11个省份现行医保政策对MDR-TB发挥积极的补偿作用;但当治疗费用总额提高时,部分省份补偿额度将相对不足,CHE发生率也会相应增加。因此,建议进一步提升补偿标准。

Objective To compare the differences of medical insurance for multidrug-resistant tuberculosis(MDR-TB)among urban and rural residents in provinces with high tuberculosis burden,and to provide some corresponding suggestions for the improvement of relevant policies.Methods Based on the incidence of active pulmonary tuberculosis,the provinces were included and compared their medical insurance from three aspects:the mode and standard,the effect,and the increasing possibility.The effect was measured by the incidence and decline of catastrophic health expenditure(CHE)before and after reimbursement;and the increasing possibility was evaluated by the proportion of per capita reimbursement to per capita GDP of each province.Results Eleven provinces were included:the mode of insurance implemented in 7 provinces were case-based payments,and those in other 4 provinces were specific outpatient reimbursement.Among 11 provinces,the ceilings of reimbursement in Chongqing and Guangxi could reach 100000 yuan per case,and Xinjiang had the highest reimbursement proportion of both in-patient and out-patient,up to 90%and 100%respectively.Before reimbursement,families of urban and rural residents in 11 provinces would face CHE if the treatment cost was 33000 yuan per case.However,after reimbursement,CHE would be occurred only in those of one province.When the treatment cost rose to 50000 yuan per case,families from 5 provinces after reimbursement would suffer CHE.The proportion of regional per capita reimbursement to per capita GDP showed that the current economic situation of each province had possibility to improve reimbursement.Conclusion When treatment cost for MDR-TB is low,the medical insurance of 11 provinces can provide sufficient support for treatment.While,when the cost increases,reimbursements in some provinces are not enough,then the families of urban and rural residents will face CHE.It suggests that reimbursement needs to be improved further.