珠海市大病保险政策对不同医疗保险人群待遇差异的影响

发布时间：2018-04-26 10:03

本文选题：大病保险 + 医保待遇　；参考：《中国卫生政策研究》2017年04期

【摘要】：目的:分析珠海市大病保险政策实施情况,评估大病保险政策对职工医保和居民医保人群待遇差异的影响。方法:采用珠海市2012年、2014年医保患者的数据,对大病保险待遇获得情况进行描述性分析,采用逻辑回归模型分析影响大病保险待遇获得概率的因素,构建三重差分模型比较大病保险政策对职工医保和居民医保人群实际报销比差距的影响。结果:大病保险政策向高年龄段、高医疗费用段、有慢性病的医保人群倾斜;控制其他因素后,同一费用段患者中职工医保患者享受大病保险待遇的概率低于居民医保患者,前者为后者的58.1%。高费用段患者享受大病保险补偿后,尽管职工医保患者的实际报销比高于居民医保患者,但二者的实际报销比差距减小了3.2个百分点。结论:大病保险政策向高医疗费用段人群倾斜,提高了高医疗费用人群实际报销比,减小了居民医保人群和职工医保人群待遇的差距,促进了医疗保障公平性。
[Abstract]:Objective: to analyze the implementation of the serious illness insurance policy in Zhuhai, and to evaluate the effect of the serious illness insurance policy on the treatment difference between the workers and the residents. Methods: the data of medical insurance patients in Zhuhai in 2012 and 2014 were used to analyze the conditions of obtaining the treatment of serious illness insurance, and the logical regression model was used to analyze the factors influencing the probability of obtaining the insurance treatment for serious illness. A triple differential model is constructed to compare the effect of the insurance policy on the gap of the actual reimbursement ratio between the employee insurance and the resident medical insurance. Results: after controlling for other factors, the insurance policy of serious illness was inclined to the people with high age, high medical expenses and chronic diseases, and the probability of the patients receiving the treatment of serious illness insurance was lower than that of the residents after controlling for other factors. The former is 58.1 of the latter. Although the actual reimbursement ratio of the employee medical insurance patients is higher than that of the resident medical insurance patients, the difference of the actual reimbursement ratio between the two groups has been reduced by 3.2 percentage points. Conclusion: the policy of serious illness insurance is inclined to the population with high medical expenses, which improves the actual reimbursement ratio of the high medical expense group, reduces the gap between the medical insurance population and the medical insurance group, and promotes the fairness of the medical security.
【作者单位】：沈阳药科大学工商管理学院;人力资源与社会保障部社会保障研究所;珠海市人力资源和社会保障局;
【分类号】：F842.684;R197.1

【相似文献】