新疆兵团门诊共济实施现状分析

Analysis of the Current Status of the Implementation of Outpatient Mutual-aid Mechanism in Xinjiang Corps

目的:了解新疆兵团职工基本医疗保险门诊共济保障制度实施现状,为其更好地发挥共济保障功能提出可行性建议。方法:使用德尔菲法确定调查问卷,随机抽取兵团某两师市为调查对象进行调查,使用Epidata3.1建立数据库,使用SPSS26.0对数据进行统计分析。结果:门诊共济保障政策知晓率达96.86%,政策了解途径以医院药店等医疗机构宣传为主,97.36%的参保人对于利用不同报销比例引导适合门诊治疗住院的患者前往门诊就医的举措较为满意,但仍有16.76%的参保人认为当前报销比例对于解决门诊就诊需求无影响或不清楚。结论:新疆兵团职工基本医疗保险基金统筹账户和个人账户结构不合理情况逐步改善,要继续加强宣传引导,合理制定起付线和支付比例,充分发挥个人账户共济功能,继续推进门诊共济保障机制的实施,保证医保基金健康可持续发展。

Objective:To understand the implementation status of the mutual assistance system for the basic medical insurance of employees in Xinjiang Corps,and to put forward feasible suggestions for its better play of the mutual assistance guarantee function.Methods:The Delphi method was used to determine the questionnaire,and two cities of the Corps were randomly selected as the survey objects.Epidata3.1 was used to establish the database,and SPSS26.0 was used to analyze the data statistically.Result:The awareness rate of outpatient mutual support policy reached 96.86%,and the main way to understand the policy was publicity by medical institutions such as hospitals and pharmacies.97.36%of the insured were satisfied with the measures to guide patients suitable for outpatient treatment and hospitalization to outpatient treatment by using different reimbursement ratios.However,16.76%of the insured still believe that the current reimbursement rate has no impact or is unclear to solve the needs of outpatient visits.Conclusion:The unreasonable structure of pooling account and individual account of Xinjiang Corps employees'basic medical insurance fund is gradually improved.It is necessary to continue to strengthen publicity and guidance,rationally formulate the mow line and payment ratio,give full play to the mutual aid function of individual account,continue to promote the implementation of the mutual support mechanism for outpatient service,and ensure the healthy and sustainable development of the medical insurance fund.