上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (10): 1360-.doi: 10.3969/j.issn.1674-8115.2012.10.018

• 论著（卫生事业管理） • 上一篇    下一篇

上海儿童医疗保险制度报销水平实证分析

任益炯1, 江厚佳2, 张云婷1, 王汉松1, 张录法2, 江忠仪1   

  1. 1.上海交通大学 |医学院附属上海儿童医学中心党委办公室, 上海 200127； 2.上海交通大学国际与公共事务学院, 上海 200030
  • 出版日期:2012-10-28 发布日期:2012-11-05
  • 通讯作者: 江忠仪, 电子信箱: jiangzy@shsmu.edu.cn。
  • 作者简介:任益炯（1973—）, 男, 副研究员, 博士；电子信箱: renyiz2001@yahoo.com.cn。
  • 基金资助:

    上海市科委基金（11692105000）和上海市卫生局基金（2010190）

Empirical analysis of reimbursement level of children´s medical insurance in Shanghai

REN Yi-jiong1, JIANG Hou-jia2, ZHANG Yun-ting1, WANG Han-song1, ZHANG Lu-fa2, JIANG Zhong-yi1   

  1. 1.Shanghai Children´s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China；2.School of International and Public Affairs, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2012-10-28 Published:2012-11-05
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 11692105000；Shanghai Municipal Health Bureau Foundation, 2010190

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摘要：

目的 调查分析当前儿童大病重病的疾病经济负担和在上海医疗保险制度中的实际报销水平，为完善上海市儿童医疗保障制度提供借鉴。方法 收集上海三家儿童专科医院2008—2010年两类6种儿童大病重病1 917例患者的均次就诊费用资料，使用非参数检验方法对其进行分析。结果 上海儿童大病重病患者的实际报销比例偏低，均值69.88%，未达到90%的要求值。不同类型大病重病的报销水平存在显著差异，最高为80.85%，最低仅为47.18%。6种疾病的少儿基金的报销比例均显著低于居民医疗保险的报销比例，差异有统计学意义（P=0.000）。结论 上海儿童医疗保险制度有待完善，政府可考虑对上海儿童医疗保险制度进行整合，适当提高筹资水平和报销水平，提高儿童健康保障水平。

关键词: 上海市, 儿童医疗保险, 大病重病, 报销水平

Abstract:

Objective To investigate the economic disease burden and true level of reimbursement of children with serious illness in Shanghai, and to provide reference for the perfection of Shanghai children’s medical insurance system. Methods The data of medical expense of 1 917 children with 6 types of serious diseases from 2008 to 2010 in three pediatric hospitals were collected, and the mean medical expense was analysed with non-parametric test. Results The true level of reimbursement of children with serious illness was relatively lower, with the average level of 69.88%, which was lower than the required value of 90%. Significant differences in reimbursement levels existed among different types of diseases, with the highest of 80.85% and the lowest of 47.18%. The reimbursement level of 6 types of serious diseases of Mutual Fund of Children Hospitalization was significantly lower than that of Basic Medical Insurance for Urban Residents (P=0.000). Conclusion There is room for improvement of Shanghai children's medical insurance system. The integration of existing Shanghai children's medical insurance is advised, and the financing and reimbursement level should be elevated, so as to enhance the level of childrens health insurance.

Key words: Shanghai, children´s medical insurance, serious diseases, reimbursement