湖北省职工医保门诊慢性病保障政策研究

Study on Protection Policy of Outpatient Chronic Diseases of Medical Insurance for Employees in Hubei Province

城镇职工医保门诊慢性病统筹改革是大势所趋,目前我国以慢性病为主的门诊保障政策碎片化、无序化问题严重,影响了参保人公平享受门诊保障待遇,同时掣肘了门诊统筹改革的推进。本文收集、整理了湖北省17个市、州的职工医保门诊慢性病、门诊特殊病、门诊重症等相关政策,从政策名称、病种目录、管理模式、保障水平及共病患者待遇管理办法等方面进行对比分析,寻找改革切入口,为湖北省职工医保门诊慢性病统筹改革提供实证参考。

The overall reform of urban employees’outpatient chronic diseases of medical insurance is a general trend.At present,the fragmentation and disorder of outpatient security policy based on chronic diseases in China is a serious problem,which affects the insureds’fair enjoyment of outpatient security treatment as well as restricts the promotion of the reform of outpatient service as a whole.This paper collects and collates the policies related to employees’medical insurance of outpatient chronic diseases,special diseases and severe diseases in17 cities and states of Hubei Province,which comparatively analyzes from the aspects of policy name,disease catalogue,management model,security level and co-disease treatment management methods and so on,looking for the entry point of reform,to provide empirical reference for the overall reform of employees’medical insurance of outpatient chronic diseases in Hubei Province.