健康发展与政策研究2024，Vol.27Issue(5)：396-402,7.DOI:10.12458/HDPR.202406013
我国职工基本医疗保险门诊共济保障下门诊慢特病保障政策比较分析
Comparative analysis on the outpatient chronic and catastrophic disease support policies under the outpatient co-insurance coverage of employee basic medical insurance in China
摘要
Abstract
Objective To comb the policies regarding the outpatient chronic and catastrophic diseases (OCCDs) under the outpatient co-insurance of employee basic medical insurance in China,and to offer insights for further standardization of OCCDs support.Methods A comprehensive collection of policy documents of 31 provinces (including municipalities directly under the central government and autonomous regions) were assembled for a comparative study of the OCCDs support across regions.This analysis encompassed several key aspects,including the degree of policy unification,the scope of the OCCDs support,the reexamination period of diseases in the catalogue,the coverage of comorbidities,and the level of support.Results Significant discrepancies in OCCDs support in different regions were identified,including the disease entry standard,the scope of covered diseases,and the support level.Disorder and fragmentation are prominent features of China's OCCDs support policy.Conclusion It is imperative to strengthen the top-level design,gradually consolidate the admission criteria for OCCDs via top-down approach,and formulate a catalogue of OCCDs,so as to lay the foundation for further equalization benefit and direct settlement of OCCDs in different insurance regions.关键词
门诊慢特病/职工基本医疗保险/共病管理/共济保障Key words
outpatient chronic and catastrophic diseases/employee basic medical insurance/comorbidity management/co-insurance support分类
医药卫生引用本文复制引用
李慧慧,向晨,张治国..我国职工基本医疗保险门诊共济保障下门诊慢特病保障政策比较分析[J].健康发展与政策研究,2024,27(5):396-402,7.基金项目
国家社会科学基金(24BGL265) （24BGL265）
