摘要
本文通过对西南地区Z县的实证分析,揭示了低收入人口的实际医疗费用支出及保障效果。研究发现,尽管三重保障在减轻低收入患者医疗负担方面发挥了积极作用,但是大病患者仍面临较高返贫风险。Z县医疗支出数据表明,低收入大病患者的名义报销比例处于较高水平,但实际报销比例相对较低,自付费用较高;另外,大病保险报销具有“雨露均沾”倾向,未能集中将有限资源向重特大病患者倾斜,难以减轻患者大额医疗费用支出负担。建议扩大城乡居民基本医保报销目录,降低患者政策报销范围外的支出压力;完善大病保险机制,增强精准保障能力,优化报销结构;构建多元保障体系,进一步降低大病患者的返贫风险。通过上述措施的优化,或可在共同富裕背景下有效提升低收入人口的医疗保障水平,促进健康公平。
Abstract
This study reveals the actual medical expenses and guarantee effects of low-income populations based on an empirical analysis of Z County in Southwest China. The findings show that while the triple-layer healthcare security system has reduced the medical burden of low-income patients, the group with serious illness still faces a significant risk of falling back into poverty. Z county’s medical expenditure data indicates that while the nominal reimbursement rate for low-income patients with critical illness is relatively high, the actual reimbursement rate is relatively low, leading to relatively high out-of-pocket expenses for these patients. Additionally, the reimbursement for critical illness tends to be distributed evenly, failing to concentrate limited resources on patients with the most severe and critical illness, which makes it challenging to alleviate the substantial medical costs incurred by critically ill patients. The reimbursement catalogue of basic medical insurance for urban and rural residents should be expanded to alleviate the expenditure pressure outside the scope of patient policy reimbursement. The mechanism of major illness insurance should be improved, the ability of precise guarantee should be enhanced, and the reimbursement structure should be optimized. A diversified guarantee system should be established to reduce the risk of returning to poverty among patients with critical illness. Through the optimization of these measures, the healthcare security level of low-income populations could be effectively elevated, and health equity could be promoted in the context of common prosperity.
关键词
低收入人口 /
医疗费用 /
医疗保障 /
大病保险 /
返贫风险 /
健康公平
Key words
low-income population /
medical expenses /
healthcare security /
critical illness insurance /
risk of returning to poverty /
health equity
杨立雄, 李慧杰.
低收入人口疾病返贫风险与医疗保障现状研究——基于Z县的实证分析[J]. 中国医疗保险. 2024, 0(11): 18-27 https://doi.org/10.19546/j.issn.1674-3830.2024.11.002
Study on Risks of Returning to Poverty Due to Disease and the Current Status of Healthcare Security for Low-Income Populations——Based on an Empirical Analysis of Z County[J]. China Health Insurance. 2024, 0(11): 18-27 https://doi.org/10.19546/j.issn.1674-3830.2024.11.002
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