Research on the Current Status and Optimization Strategies of Medical Insurance Payment for Outpatient Chronic and Special Diseases in Guizhou Province &#x02014;&#x02014;Taking Rheumatoid Arthritis as an Example

doi:10.19546/j.issn.1674-3830.2026.1.012

China Health Insurance ›› 2026, Vol. 0 ›› Issue (1) : 94-99. DOI: 10.19546/j.issn.1674-3830.2026.1.012

Research on the Current Status and Optimization Strategies of Medical Insurance Payment for Outpatient Chronic and Special Diseases in Guizhou Province ——Taking Rheumatoid Arthritis as an Example

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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.

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outpatient chronic and special disease / rheumatoid arthritis / current status of medical insurance payment / study of optimization strategy

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Research on the Current Status and Optimization Strategies of Medical Insurance Payment for Outpatient Chronic and Special Diseases in Guizhou Province ——Taking Rheumatoid Arthritis as an Example[J]. China Health Insurance. 2026, 0(1): 94-99 https://doi.org/10.19546/j.issn.1674-3830.2026.1.012

References

[1] 雷桃,顾思雨,杨金侠.医保支付促进慢性病防控的需方调查分析[J]. 卫生经济研究,2024,41(12):37-40.
[2] 常煜博,贺顺,王侠,等.基于疾病特征的医保支付方式优化策略研究——以结核病为例[J]. 卫生经济研究,2024,41(06):31-33+38.
[3] 李利青,张逢,彭馥芝,等.类风湿关节炎实验性动物模型研究进展[J]. 中国药理学通报,2021,37(11):1492-1497.
[4] 于兴宝. 类风湿关节炎与骨关节炎患者的临床特点探讨[J]. 黑龙江科学,2019,10(20):34-35.
[5] 田颖,谢华灵,吴斌,等.类风湿关节炎治疗达标率的影响因素[J]. 护理研究,2024,38(03):549-551.
[6] 令垚,张文滨,王仕鸿,等.1990—2021年中国类风湿关节炎疾病负担变化趋势分析及预测研究[J]. 中国全科医学,2025,28(15):1914-1922.
[7] 谢文慧,张卓莉.难治性类风湿关节炎的治疗策略[J]. 中国实用内科杂志,2024,44(12):1006-1010.
[8] OLIVEIRA R A, FIERRO I M.New strategies for patenting biological medicines used in rheumatoid arthritis treatment[J]. Expert opinion on therapeutic patents, 2018, 28(8): 635-646.
[9] 喻建平. 类风湿关节炎治疗经验[J]. 风湿病与关节炎,2016,5(06):31-33.
[10] 鲁志鸿,吴敏,穆晓敏,等.门诊共济背景下职工基本医疗保险个人账户改革方案设计与释放资金测算[J]. 中国卫生经济,2025,44(02):46-49.
[11] 商昌斌.去年贵阳贵安超千万人次享受职工门诊统筹待遇[N]. 贵阳日报,2025-02-12(002).
[12] 李卓霞,谢仙萍,苗华丽,等.类风湿关节炎病人延续护理质量现状及影响因素分析[J]. 护理研究,2020,34(22):4072-4076.
[13] 李小升,贾玲,周伟,等.不同医保支付方式的肺癌患者住院费用分析[J]. 中国病案,2022,23(11):41-45.
[14] 阮博宇,边云凤,马宇豪,等.紧密型县域医共体医保总额预算典型模式及优化路径[J]. 卫生经济研究,2025,42(06):63-67+72.
[15] 丁萌,覃双凌.紧密型县域医共体建设中的医保支付政策改革探讨[J]. 中国集体经济,2025(19):82-85.
[16] 靳卫东,陈子源,郑浩天.医联体建设有助于农民医疗消费下沉吗?[J]. 消费经济,2024,40(05):12-24.
[17] 刘冠宏,黎珍羽,许光建.以人民为中心的医疗服务价格改革理论逻辑与实践路径[J]. 价格理论与实践,2024(12):41-46.
[18] 诸宏明,张艳春,秦江梅.以人员为重点推进紧密型县域医共体“四个下沉”的典型实践与策略分析[J]. 中国卫生经济,2025,44(05):64-69.
[19] 肖楠,刘国恩.基层首诊政策对患者就医选择和医疗费用的影响[J]. 世界经济,2025,48(07): 224-248.
[20] 刘文迪,王子怡,刘苏仪,等.兰州市居民惠民保续保意愿及其影响因素[J]. 医学与社会,2025, 38(03):86-92+107.
[21] 徐媛.连续参保满4年,居民大病保险支付限额提升[N]. 长沙晚报,2025-04-07(003).
[22] 李莉,贾红燕,王彤,等.紧密型医联体背景下专科联盟模式探索与实践[J]. 中国医院管理,2025,45(06):89-91.
[23] 涂怡欣,郁建兴.县域医共体改革:构建整合型医疗卫生服务体系的中国方案[J]. 治理研究,2025,41(01):81-90+159.
[24] 宋扬,孙宇,李佳慧.紧密型县域医共体建设存在问题与对策研究[J]. 中国农村卫生,2025, 17(03):21-24+42.
[25] 李玉海,王秀敏.中医辨证分型结合西医分期治疗类风湿性关节炎临床研究[J]. 新中医,2015, 47(09):120-122.
[26] 赵云.我国分级医疗体系建构路径比较[J]. 中国卫生事业管理,2013,30(04):244-246+250.