重庆市主城区无偿献血者商业保险理赔情况的回顾性分析

Retrospective analysis on commercial insurance claims of voluntary blood donors in main urban area of Chongqing Municipality

目的探讨重庆市主城区无偿献血者商业保险的理赔情况。方法选择2016年7月至2018年6月,于重庆市主城区参加无偿献血的311558例献血者为研究对象。献血者年龄为18~60岁;男性献血者为147070例,女性为164488例。由重庆市血液中心作为投保人,所有献血者均统一参加献血商业保险。采用回顾性的研究方法,调查获得保险理赔的无偿献血者中,不同保险责任、就诊方式、理赔金额的分布。不同保险责任理赔金额的构成比的比较,采用χ2检验。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①本研究311558例无偿献血者中,获得保险理赔者为155例,理赔率为0.05%(155/311558)。其中,按照保险责任划分,献血7 d内发生局部献血不良反应者最多,为59例(38.1%,59/155),献血3 d内意外身故者最少,仅1例(0.6%,1/155)。按照就诊方式划分,住院治疗者为131例(84.5%,131/155),门诊治疗者为23例(14.8%,23/155),意外身故者为1例(0.7%,1/155)。②本研究获得保险理赔的155例献血者中,不同保险责任的理赔金额构成比比较,差异无统计学意义(χ^2=7.223,P=0.125);住院医疗理赔金额为5000~10000元者最多,为79例(60.3%);门诊治疗理赔金额为600~1000元者最多,为11例(47.8%)。结论目前,重庆市血液中心施行的无偿献血商业保险及理赔制度,切实可行,能够保障献血者利益,并且有利于无偿献血队伍的招募和稳定。

Objective To explore the commercial insurance claims of voluntary blood donors in the main urban area of Chongqing.Methods From July 2016 to June 2018,a total of 311558 blood donors who participated in voluntary blood donation in the main urban area of Chongqing Municipality were selected as subjects.The age of blood donors was ranged from 18 to 60 years.Among all blood donors,there were 147070 male blood donors and 164488 females.All the blood donors participated in the blood donation commercial insurance,which insured by Chongqing Blood Center.The distribution of different insurance liabilities,treatment methods,and claims amount of voluntary donors who received insurance claims were surveyed by retrospective analysis method.The composition ratios of different insurance liability claims amounts were compared by chi-square test.The procedures followed in this study met the requirements of World Association Declaration of Helsinki revised in 2013.Results①Among the 311558 voluntary blood donors in this study,there were 155 cases who received insurance claims,and the claim rate was 0.05%(155/311558).According to the insurance liabilities,the number of adverse reactions of local blood donation within 7 d of blood donation was the highest of 59 cases(38.1%,59/155),and the number of accidental deaths within 3 d of blood donation was the least of 1 case(0.6%,1/155).According to the treatment method,there were 131 cases(84.5%,131/155)receiving inpatient treatment,and 23 cases(14.8%,23/155)receiving outpatient treatment,only 1 case(0.7%,1/155)died by accident.②Among the 155 blood donors who received insurance claims in this study,there were no statistically significant differences in the composition ratios of claims amounts for different insurance liabilities(χ^2=7.223;P=0.125).The inpatient treatment claims amounted to 5000-10000 yuan,with the largest number of 79 cases(60.3%);the outpatient treatment claims amounted to 600-1000 yuan,with the largest number of 11 cases(47.8%).Conclusions At present,the voluntary blood donation commercial insurance and insurance claims system implemented by Chongqing Blood Center is practical,which can protect the interests of blood donors,and be conducive to the recruitment and stability of voluntary blood donation teams.