摘要
目的:通过梳理我国31个省级单位城乡居民大病保险政策的特点、落实情况及实施效果差异,对比研究国外经验,为我国城乡居民大病保险政策的可持续发展提供建议。方法:文献研究结合实地调研和访谈,对结果数据进行总结分析,借鉴国外重大疾病保险模式及经验,提出完善我国城乡居民大病保险的建议。结果:截至2015年末,我国已有31个省级单位均已全面实行城乡居民大病保险,但不同省份对筹资标准、起付线、封顶线和报销比例的政策要求及实施效果存在差异。结论:应建立更加合理的医疗费用管控机制,推进医疗保障服务一体化管理,构建筹资动态调节机制和风险联动机制。
Objective： To analyze and summariz the characteristics, implementations and effects of the Critical Illness Insurance for Urban and Rural Residents in 31 provincial-level units, and to compare and study the foreign experience, so as to put forward suggestions and ideas for perfecting the critical illness insurance for urban and rural residents in China. Methods： Literature research combined with field survey was performed, and the results were summarized and analyzed. By drawing lessons from foreign major disease insurance mode and experience, recommendations were put forward to improve the serious illness insurance of urban and rural residents in China. Results： China had implemented a critical illness insurance at the end of 2015, but the policy for urban and rural residents and implementation effect varied among different provinces. Conclusion： It is necessary to establish reasonable mechanism of controlling medical costs, promote health care service integration management, and build the mechanism for dynamic adjustment and risk linkage.
作者
桑晓冬
魏国旭
陈敬
韩晟
史录文
Sang Xiaodong Wei Guoxu Chen Jing Han Sheng Shi Luwen(School of Pharmaceutical Sciences Peking University, Beijing 100191, China International Research Center of Medicinal Administration, Peking University, Beijing 100191, China)
出处
《中国药事》
CAS
2016年第12期1183-1189,共7页
Chinese Pharmaceutical Affairs
关键词
医疗保障制度
大病保险制度
筹资标准
起付线
封顶线
报销比例
medical security system
the critcal illness insurance
funding criteria
deductible
cap line
reimbursement rate
