我国省会城市居民医保门诊慢性病政策分析

doi:10.5246/jcps.2021.10.073

中国药学(英文版) ›› 2021, Vol. 30 ›› Issue (10): 845-850.DOI: 10.5246/jcps.2021.10.073

• 【药事管理与临床药学专栏】 • 上一篇下一篇

我国省会城市居民医保门诊慢性病政策分析

罗宁泰¹^,^#, 熊亚娟¹^,^#, 刘力¹, 江滨¹^,^*(), 岳剑颖²

1. 北京大学医学部药学院药事管理与临床药学系, 北京 100191
2. 北京大学医学部医学人文学院, 北京 100191

收稿日期:2021-05-12 修回日期:2021-06-10 接受日期:2021-06-25 出版日期:2021-10-24 发布日期:2021-10-24
通讯作者: 江滨
作者简介:
+ Tel.: +86-13601100121, E-mail: binjiang@bjmu.edu.cn

Analysis of reimbursement policy for outpatient chronic diseases in basic medical insurance for urban residents in China provincial capitals

Ningtai Luo¹^,^#, Yajuan Xiong¹^,^#, Li Liu¹, Bin Jiang¹^,^*(), Jianying Yue²

1 Department of Administrative and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
2 School of Health Humanities, Peking University Health Science Center, Beijing 100191, China

Received:2021-05-12 Revised:2021-06-10 Accepted:2021-06-25 Online:2021-10-24 Published:2021-10-24
Contact: Bin Jiang
About author:
# These authors contributed equally to this work.

摘要/Abstract

摘要：

门诊慢性病是我国基本医疗保险制度的重要内容。本文对我国省会城市城乡居民医保门诊慢性病政策从病种、待遇、准入和就医管理等方面进行分析, 发现存在制度碎片化、病种设置差异大、待遇不公平、执行管理困难、政策衔接和配套措施不完善等问题, 建议完善顶层设计, 建立规范的病种遴选标准, 合理设定筹资和待遇水平, 加强执行管理, 完善配套措施, 加强制度衔接, 坚持三医联动深化改革等。

关键词: 门诊慢性病, 基本医保, 报销政策

Abstract:

Reimbursement policy for outpatient chronic diseases is an important part of the basic medical insurance scheme in China. The reimbursement policy for outpatient chronic diseases in basic medical insurance for urban residents of provincial capitals in China were analyzed from the perspectives of disease types, benefits package, qualification and health service access. Proposals to improve policy design, establish standardized disease inclusion criteria and set reasonable benefits package, strengthen management and complete supporting policy, strengthen policy coordination were put forward according the existing problems such as fragmented policy, great difference in disease types and benefit package, supervision difficulty, incomplete policy framework and lack of policy coordination.

Key words: Outpatient chronic diseases, Basic medical insurance, Reimbursement policy

Supporting:

罗宁泰, 熊亚娟, 刘力, 江滨, 岳剑颖. 我国省会城市居民医保门诊慢性病政策分析[J]. 中国药学(英文版), 2021, 30(10): 845-850.

Ningtai Luo, Yajuan Xiong, Li Liu, Bin Jiang, Jianying Yue. Analysis of reimbursement policy for outpatient chronic diseases in basic medical insurance for urban residents in China provincial capitals[J]. Journal of Chinese Pharmaceutical Sciences, 2021, 30(10): 845-850.

参考文献 8

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我国省会城市居民医保门诊慢性病政策分析

Analysis of reimbursement policy for outpatient chronic diseases in basic medical insurance for urban residents in China provincial capitals

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