2018-2021年重庆市预防接种异常反应保险补偿分析

Insurance-based compensation for adverse reactions following immunizations in Chongqing,2018-2021

目的分析重庆市预防接种异常反应保险补偿实施情况。方法收集2018年7月-2021年6月预防接种异常反应保险补偿个案,描述性分析补偿金额及其分布特征。结果在实施预防接种异常反应保险补偿期间共补偿病例4669例,补偿总金额为1523.9万元,平均补偿金额为0.3万元/例;其中基础保险、补充保险补偿病例分别为36例、4633例,平均补偿金额分别为1.1万元/例、0.3万元/例。在总补偿金额中,<1岁、1岁、2岁、≥3岁病例补偿金额分别占80.7%、16.1%、2.8%、0.4%;乙型肝炎疫苗、卡介苗、脊髓灰质炎疫苗补偿病例补偿金额分别占26.0%、14.0%、13.4%。在基础保险补偿中,过敏性皮疹、卡介苗淋巴结炎病例补偿金额分别占25.4%、15.7%;在补充保险补偿中,上呼吸道感染、肺炎病例补偿金额分别占47.6%、31.4%。在作出诊断或鉴定结论30d内支付补偿款的病例比例为90.5%。结论重庆市引入预防接种异常反应保险补偿后补偿范围和效率大幅提高;需进一步完善保险补偿机制。

Objective To assess implementation of insurance-based compensation for adverse reactions following immunization in Chongqing city.Methods We obtained data on compensation for adverse reactions following immunizations from July 2018 to June 2021 and analyzed characteristics of compensation amounts.Results A total of 4669 cases received a compensation of 15.239 million yuan during the implementation of insurance-based compensation for adverse reactions,for an average of 3 thousand yuan per case;36 and 4633 cases were compensated by basic and supplementary insurances,for an average of 11 and 3 thousand yuan per case,respectively.Compensation amounts for<1-,1-,2-,and≥3-year-old cases accounted for 80.7%,16.1%,2.8%,and 0.4%of total compensation;hepatitis B vaccine,bacillus Calmette-Guerin vaccine(BCG),and poliomyelitis vaccine accounted for 26.0%,14.0%,and 13.4%of total compensation.Compensation amounts for allergic rash and BCG-associated lymphadenitis accounted for 25.4%and 15.7%of basic insurance-based compensation while upper respiratory tract infection and pneumonia accounted for 47.6%and 31.4%of supplementary insurance-based compensation.Ninety percent of cases received compensation within 30 days of completing diagnosis or identification.Conclusions The scope and efficiency of compensation were greatly increased after introducing insurance-based compensation for adverse reactions following immunization in Chongqing.We should further improve the mechanism of insurance-based compensation.