摘要
门诊特殊疾病补偿政策是我国基本医保制度的重要组成部分,对提高特殊疾病患者门诊费用补偿水平、引导医疗服务利用行为和改善患者健康状况、促进健康中国建设都具有积极意义。当前,农村居民基本医保对门诊特殊疾病的补偿政策尚缺乏国家级政策文件的统一规范,各地在政策目标、保障对象、纳入病种和补偿政策等方面均存在较大差异,在供需方管理及政策衔接方面也面临一些问题。建议制订国家级政策文件对这一政策的关键要素做出明确规定,以国家或省为单位开展病种遴选及相关技术标准制订等工作,并有针对性地开展统筹区域内医疗机构专科服务能力建设,以规范和完善门诊特殊疾病补偿政策。
The reimbursement policy for outpatient special diseases is an important part of China’s basic medical insurance systems. It plays a positive role in improving the actual reimbursement ratio of outpatient special diseases’ medical expenses,guiding the utilization of medical services,improving patients’ health and promoting the construction of Healthy China. At present,there is no national policy on regulating the reimbursement of outpatient special diseases in Rural Residents’ Basic Medical Insurance. There are major differences in policy objectives,policy targets,special diseases and reimbursement policies among pooling areas. There are still some problems in the management of medical services and patients and policy coordination. To regulate and improve the reimbursement policy for outpatient special diseases,it is suggested that national policy documents be developed to clearly define the key elements of this policy,conduct disease selection and related technical standards development on national or provincial level,and targeted develop the capacity of specialist services of health facilities in pooling areas.
作者
赵东辉
宋大平
崔雅茹
ZHAO Dong-hui;SONG Da-ping;CUI Ya-ru(China National Health Development Research Center,Beijing,100044,China)
出处
《中国初级卫生保健》
2019年第10期11-14,18,共5页
Chinese Primary Health Care
基金
国家卫生计生委（原）基层卫生司委托“新农合特殊病种大额门诊费用补偿政策现状调查与分析研究项目”
关键词
基本医疗保险
门诊特殊疾病补偿政策
规范化
basic medical insurance
reimbursement policy for outpatient special diseases
regulation
