目的: 分析贵州省类风湿关节炎患者在职工医保与城乡居民医保中的支付差异及其影响,以期为优化相关支付政策提供参考。方法: 采用文献分析、政策比较与医疗机构实证数据相结合的方法进行系统研究,通过对比职工医保与城乡居民医保的报销政策与费用结构,分析两类医保在门诊慢特病保障中的支付差异及其对患者医疗行为的影响。结果: 职工医保的报销比例虽高于城乡居民医保,但患者门诊次均医疗费用却高于城乡居民医保患者。同时,城乡居民医保患者的个人自付费用在其可支配收入中占比更高。结论: 城乡居民医保与职工医保在慢特病支付中存在显著差异,这一差异影响了患者的医疗选择行为。建议从优化支付结构、强化基层医疗服务能力、建立分级诊疗付费机制等方面完善相关政策。
Abstract
Objective: The paper analyzes the payment differences and impacts of rheumatoid arthritis patients in employees' medical insurance and urban-rural residents' medical insurance in Guizhou Province, in order to provide reference for optimizing relevant payment policies. Methods: A systematic study was conducted by combining literature analysis, policy comparison, and empirical data from medical institutions. By comparing the reimbursement policies and cost structures of employees' medical insurance and urban-rural residents' medical insurance, the payment differences between the two types of medical insurance in outpatient chronic and special disease and their impact on patients' medical behavior were analyzed. Results: Although the reimbursement ratio of employees' medical insurance is higher than that of urban-rural resident medical insurance, the average medical expenses per outpatient visit of patients are higher than those of urban-rural residents' medical insurance patients. Meanwhile, the personal out-of-pocket expenses of urban-rural residents' medical insurance patients account for a higher proportion of their disposable income. Conclusion: There is a significant difference between urban-rural resident medical insurance and employees' medical insurance in the payment of chronic and special diseases, which affects patients' medical choice behavior. We suggest improving relevant policies from optimizing payment structures, strengthening the capacity of primary healthcare services, and establishing a tiered diagnosis and treatment payment mechanism.
关键词
门诊慢特病 /
类风湿关节炎 /
医保支付现状 /
优化策略研究
Key words
outpatient chronic and special disease /
rheumatoid arthritis /
current status of medical insurance payment /
study of optimization strategy
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基金
国家自然科学基金“基于HIF-1a调控细胞自噬探讨化合物Q-1抑制类风湿关节炎骨破坏机制”（82160805）
