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目的:分析镇江市居民医保部分重大疾病住院治疗运行情况及补偿支付方式。方法:对镇江市区2014年居民基本医疗保险部分重大疾病住院治疗有关数据进行分析,结合2014年由商业保险机构承办的镇江市居民大病保险的运行方式和经办管理方法,进行对比。结果:镇江市居民重大疾病住院治疗医保制度内费用补偿比达92%以上,总费用实际补偿比平均达70%以上,补偿幅度为居民大病保险所不及,然而覆盖病种有限。结论:建议将重大疾病病种全部纳入按病种付费制度;居民重大疾病逐步向居民大病保险过渡,同时扩大居民大病保险支付范围和降低大病保险起付标准,提高实际支付率。
Objective: To analyze the operation and compensation payment of some major diseases in Zhenjiang residents. Methods: The data of hospitalization for some major diseases of residents ’basic medical insurance in Zhenjiang City in 2014 were analyzed. Combining with the running methods and handling methods of residents’ illness insurance in Zhenjiang City hosted by commercial insurance institutions in 2014, the comparison was made. Results: In Zhenjiang City residents major illness hospitalization medical insurance system cost compensation ratio of 92% or more, the actual cost of compensation than the average of more than 70%, the compensation rate is less than residents of serious illness insurance, however, covers a limited number of diseases. Conclusion: It is suggested that all major disease types should be included in the payment system according to disease types. Major diseases of residents should be gradually transferred to residents with serious illness insurance. At the same time, the scope of payment for resident illness insurance should be expanded and the starting standard of serious illness insurance should be reduced so as to raise the actual payment rate.