【摘要】 目的:分析多层次医疗保障制度对重特大疾病的实际保障效果。方法:分地区、总费用水平和病种计算延安市基本医疗保险、大病保险和医疗救助对重特大疾病的保障效果。结果:延安市重特大疾病医疗费用经基本医疗保险、大病保险和医疗救助三个层次的报销后,平均保障水平为77.14%;住院医疗费用的补偿比例随总费用上升而下降;总费用超过20万元的患者,个人自付比例超过35%。结论:持续完善医保药品目录、诊疗项目目录,在目录层面实现对基本诊疗需求的全覆盖,同时重视高额医疗费用的补偿,增强制度的兜底保障作用;各统筹地区应结合本地区实际,出台相适应的重特大疾病保障政策,做到精准施策。更多还原

【Abstract】 Objective To analyze the actual security effect of the multi-level medical insurance system on critical illness. Methods This paper estimated the effect of basic medical insurance, critical illness insurance and medical assistance on critical illness in Yan’an city stratified by region, total cost level and disease. Results The average reimbursement rate was 77.14% for critical illness after reimbursement from basic medical insurance, critical illness insurance and medical assistance. The reimbursement of inpatient medical costs decreased with the increase of total expenses. For patients whose total expenses were over 20 thousands(RMB), the personal out-of-pocket ratio exceeded 35%. Conclusion It is necessary to improve the reimbursement list of drugs and medical items, so that full coverage of basic medical needs could be achieved by reimbursement list support. Also, it is suggested to pay attention to compensation for high medical expenses,in order to strengthen the guarantee for urgent-need groups. And governments in reimbursement pools should introduce relative policies about critical illness insurance based on their practices.更多还原