目的: 在我国低生育率背景下,基于包容性发展视域的理论框架,通过江苏省范围内的田野调查,探讨儿童医疗保障制度实施现状,识别制度优化路径,旨在纾解生育压力,助力儿童医疗保障事业高质量发展。方法: 采用混合研究方法,对江苏苏州、扬州、淮安等地医保主管部门以及儿童医院医保部门进行结构化访谈,并在调查区域开展问卷调查,运用基于安德森模型构建的Ordered Logistic模型进行数据分析。结果: 实证研究表明,参保费评价显著正向影响对儿童医疗保障政策的评价,就医需求满足评价显著影响对儿童医疗保障政策的评价,医保政策感知评价显著影响对儿童医疗保障政策的评价。结论: 政策优化应着眼于参保费结构调整与医保门诊待遇加权,运用多种方法提高医保宣传覆盖率,适当扩大医保目录中儿童用药占比,保障基本医保基金可持续发展,推进医保政策向儿童倾斜,从而有效提升儿童医保制度效能。

Objective: In the context of low fertility, based on the theoretical framework of the inclusive development perspective, the paper explores the current status of the children's healthcare security system and identify the system optimization path, to relieve the pressure of childbirth and promote the high-quality development of children's healthcare security through field surveys within Jiangsu Province. Methods: A mixed research method was adopted, that is, structured interviews were conducted with medical insurance authorities and medical insurance departments of children's hospitals in Suzhou City, Yangzhou City, and Huai'an City, and questionnaire surveys were conducted in the survey area. The Ordered Logistic model based on the Anderson model was used for data analysis. Results: The empirical results show that the evaluation of insurance costs has a significant positive impact on the evaluation of the children's healthcare security policy, the evaluation of the meeting medical needs significantly affects the evaluation of the children's healthcare security policy, the evaluation of healthcare security policy perception significantly affects the evaluation of the children's healthcare security policy. Conclusion: The policy optimization should focus on adjusting the structure of insurance premiums and weighting medical insurance outpatient benefits, improving the coverage of medical insurance publicity with various methods, appropriately expanding the proportion of children's drugs in the medical insurance catalog, ensuring the sustainable development of the basic medical insurance fund, promoting the medical insurance policies supporting children, and effectively improving the effectiveness of the children's healthcare security system.