河南省某市中西医医疗保险补偿差异对比分析

发布时间：2018-05-12 19:46

本文选题：中西医 + 药物和疗法补偿　；参考：《中国卫生事业管理》2017年12期

【摘要】：目的:文章通过对比分析某市2011~2014年度医疗保险对中西医补偿的差异,为完善中西医补偿政策提出建议。方法:利用Excel软件对4年中西医医保补偿的摘要数据做描述性分析。结果:各年医保对西医药物补偿人次数所占比例约为46~48%,对西医药物补偿费用所占比例约为58~61%左右,对中医药物补偿人次数所占比例约为12~13%左右,对中医药物补偿费用所占比例约为11~12%左右,对西医疗法补偿人次数所占比例约为26~27%左右,对西医疗法补偿费用所占比例约为21~23%左右,对中医疗法补偿人次数所占比例约为11~12%左右,对中医疗法补偿费用所占比例约为2~6%左右。2011~2014年中医比西医药物医保少补偿的人次数比例差距扩大了6.92个百分点,少补偿的费用比例差距扩大了11.25个百分点;中医比西医疗法医保少补偿的人次数比例差距扩大了10.83个百分点,医保少补偿的费用比例差距扩大了14.19个百分点。结论:各年度医疗保险对中西医药物和疗法的补偿人次数和费用的构成比4年变化幅度不大;医保补偿以药物补偿为主,疗法补偿为辅;以西医药品和疗法补偿为主,以中医药物和疗法的补偿为辅。医疗保险加大了对中医的扶持力度,但中医比西医药物和疗法少补偿人次数和费用的比例差距仍然逐年扩大。
[Abstract]:Objective: to compare and analyze the difference of medical insurance compensation between traditional Chinese and western medicine in a certain city in 2011and 2014, and put forward some suggestions for perfecting the policy of compensation between traditional Chinese and western medicine. Methods: Excel software was used to analyze the summary data of medical insurance compensation in 4 years. Results: the proportion of medical insurance compensation to western medicine was about 46 to 48 per year, the proportion of medical compensation to western medicine was about 58 to 61%, and the proportion of medical compensation to traditional Chinese medicine was about 12 to 13 percent. The proportion of compensatory expenses for traditional Chinese medicine is about 1112%, that for western medicine is about 26%, and that for western medicine is about 21 23%. The proportion of the number of patients compensated for TCM treatment was about 1112%, and the proportion of compensation expenses for TCM treatment was about 2%. From 2011 to 2014, the difference between the number of people compensated by TCM and medical insurance by western medicine increased by 6.92 percentage points. The difference in the proportion of expenses with less compensation was increased by 11.25 percentage points, the difference between the number of people who were compensated less by TCM than that by Western medicine was increased by 10.83 percentage points, and the difference in the proportion of expenses with less compensation by medical insurance was increased by 14.19 percentage points. Conclusion: the number and cost of medical insurance compensation for traditional Chinese and western medicine and therapy in each year is not much different from that in 4 years, the compensation of medical insurance mainly consists of drug compensation, medical compensation is supplemented by therapy compensation, and western medicine and therapy compensation is the main compensation. The compensation of traditional Chinese medicine and therapy is supplementary. Medical insurance has increased the support for TCM, but the gap between the number of people compensated and the cost of TCM less than that of western medicine and therapy is still widening year by year.
【作者单位】：河南中医药大学;
【基金】：河南省教育厅人文社科基地项目“医疗保险对中医药卫生服务影响研究”(编号:JD-2014-02) 河南中医学院省属高校基本科研业务费专项项目“中医药NGO发展战略研究”(编号:2014KYYWF-ZZCX3-12) 河南省卫计委课题“促进社会办医发展政策研究”(编号:YWZY201459)
【分类号】：F842.684;R197.1

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