城乡居民医保“两病”患者门诊用药保障政策探讨

Discussion on Outpatient Drug Security Policies for Patients with Hypertension and Diabetes Covered by Medical Insurance for Urban and Rural Residents

自2019年9月国家医疗保障局发布相关政策以来,居民医保“两病”患者门诊用药保障机制建立已三年。本文通过分析各省及典型地区居民医保“两病”患者门诊用药报销政策,发现各地报销政策虽然起付标准、最高支付限额和支付比例有一定差异,但均呈现低起付标准和低最高支付限额特征,造成“两病”患者门诊用药报销保障不足。“两病”用药保障政策应瞄准风险,适当提高起付标准,并在基金安全的前提下尽量提高最高支付限额,更好地保护“两病”患者的经济风险。

The outpatient medication security mechanism of residents'medical insurance for hypertension and diabetes patients has been established for 3 years since the National Healthcare Security Administration released the policy in September,2019.By analyzing the reimbursement policies for outpatient medication for hypertension and diabetes patients with resident medical insurance in various provinces and typical regions,it is found that although there are certain differences in the reimbursement policies in different regions,the thresholds,caps and reimbursement ratios are all characterized by low thresholds and caps.It also resulted in insufficient guarantees for outpatient drug reimbursement for patients with hypertension and diabetes.The drug security policy for the two diseases should aim at risks,appropriately improve the thresholds,and try to increase the caps under the premise of fund security to better protect the economic risks of patients.