湖南省尘肺病农民工医疗救治救助资金绩效分析

Performance analysis of medical treatment and assistance funds for rural migrant workers with pneumoconiosis in Hunan Province

目的分析湖南省尘肺病农民工基本医疗救治救助资金的绩效情况,为政府部门继续合理投入尘肺病农民工专项救助资金提供依据。方法分析2017—2022年间湖南省尘肺病农民工基本医疗救治救助惠民政策覆盖面与总人数、医疗费用中尘肺病农民工专项救助金额占比、医保报销比例、住院医疗费用、自付费用占比等指标变化趋势,总结湖南省尘肺病农民工基本医疗专项救治救助资金使用效益情况,并对存在的问题进行分析、探讨对策。结果湖南省2017年开始政府每年投入5000万专项资金实施尘肺病农民工医疗救治救助,至2022年已连续实行6年。通过“一提一降一助”三大举措,湖南省享受尘肺病农民工基本医疗救治救助惠民政策的患者覆盖面和总人数不断增长、住院医疗费用中专项救助金额占比相对稳定、患者医保报销比例逐年上升、次均医疗费用逐年递减、患者自付费用占比逐年下降,但也存在三方面问题:(1)湖南省农民工尘肺病还处于发病高峰阶段,受救助的人数逐年小幅增长,但死亡报告机制尚未建立;(2)救治救助资金使用的公平性有待加强,存在部分患者重复享受救助而部分患者全年未享受救助的现象;(3)目前尘肺病农民工医保单病种限额支付政策具有一定局限性,无法解决医疗费用过高的危重症患者更为迫切的救助需求。结论在政府的大力支持下,湖南省尘肺病农民工救治救助工作取得了明显的成效,救治效果良好、社会效益显著,达到了促进人民群众健康、维护社会治安稳定的目的,但仍需要针对政策实施过程中出现的问题进行分析并改进,让有限的救助资金惠民效益最大化。

Objective To analyze the performance of basic medical treatment and assistance funds for migrant workers with pneumoconiosis in Hunan Province,thus to provide a basis for government departments to continue to invest special assistance funds for migrant workers with pneumoconiosis in a reasonable manner.Methods The trend of changes in indicators such as the coverage and total number of basic medical treatment and assistance policies for migrant workers with pneumoconiosis in Hunan Province from 2017 to 2022,the proportion of special assistance for migrant workers with pneumoconiosis in medical expenses,the proportion of medical insurance reimbursement,hospitalization medical expenses,and the proportion of self-payment expenses.were analyzed.The utilization efficiency of basic medical special treatment and assistance funds for migrant workers with pneumoconiosis in Hunan Province was summarized,and the countermeasures for existing problems were analyzed and explored.Results Since 2017,the government in Hunan Province had invested 50 million special funds annually to implement medical treatment and assistance for migrant workers suffering from pneumoconiosis.It had been continuously implemented for six years until 2022.Through the three major measures of"Promotion,Reduction,and Assistance",the coverage and total number of patients who enjoyed the basic medical treatment and assistance policies for migrant workers with pneumoconiosis in Hunan Province continued to increase,the proportion of specialized assistance in hospitalization medical expenses were relatively stable,the proportion of patient medical insurance reimbursement were increasing year by year,the average medical expenses were decreasing year by year,and the proportion of patient out of pocket expenses were decreasing year by year.However,there were also three problems.Firstly,the incidence of pneumoconiosis among migrant workers in Hunan Province was still at its peak,the number of people receiving assistance had increased slightly year by year,and a death reporting mechanism had not yet been established.Secondly,the fairness of the use of rescue funds needed to be strengthened,with some patients repeatedly receiving assistance while others did not receive assistance throughout the year.Thirdly,certain limitations in the current policy of limited payment for individual medical insurance types for migrant workers with pneumoconiosis,led to the problem of the more urgent assistance needs of critically ill patients with high medical expenses could not be solved.Conclusion With the strong support of the government,the treatment and rescue work for migrant workers with pneumoconiosis in Hunan Province has achieved significant results,with good treatment outcomes and significant social benefits,achieving the goal of promoting people's health and maintaining social order and stability.However,it is still necessary to analyze and improve the problems that arise during the policy implementation process to maximize the benefits of limited rescue funds for the people.