惠民保门诊慢特病衔接保障评价体系构建及应用

Construction and Application of Evaluation System for the Connection Guarantee of Outpatient Chronic and Special Diseases in Inclusive Commercial Health Insurance

目的:构建惠民保与基本医保门诊慢特病保障衔接的评价指标体系,指导惠民保产品的设计和优化。方法:采用主成分分析法确定指标体系与指标权重,对全国96款惠民保产品门诊慢特病衔接保障进行评价。结果:从保障性评估和可持续性评估两个维度,构建评价指标库;惠民保产品门诊慢特病衔接保障评价的综合得分集中在中值附近,衔接保障效果比较均衡。结论:衔接保障较优的惠民保产品呈现三大特点——重视普通门诊保障,理赔限制和程序友好,产品的性价比较高;这些也是未来惠民保设计和优化的重点。

Objective To construct an evaluation index system for the connection between inclusive commercial health insurance and basic medical insurance for outpatient chronic and special diseases,and guide the design and optimization of inclusive commercial health insurance products.Methods Principal component analysis was used to determine the index system and index weight,and the connection guarantee for outpatient chronic and special diseases in 96 inclusive commercial health insurance products in China were evaluated.Results From the two dimensions of guarantee evaluation and sustainability evaluation,the evaluation index library was constructed.The comprehensive score of the evaluation of connection guarantee for outpatient chronic and special diseases in inclusive commercial health insurance products was concentrated near the median value,and the connection guarantee effect was relatively balanced.Conclusion Inclusive commercial health insurance products with better connection guarantee have three characteristics:paying attention to the general outpatient care guarantee,fewer restrictions on claims and more convenient for claims,and higher cost performance.These are also the focus of the design and optimization of inclusive commercial health insurance in the future.