基于重大疾病总费用的大病保险补偿模式分析.pdfVIP

中国卫生事业管理 2015 年第8 期(总第 326 期) {医疗保障i 基于重大疾病总费用的大病保险补偿模式分析* 曹阳l ，李海晶1 ，高心韵2 (1.中国药科大学国际医药商学院，江苏南京 211198 ;2. 中国药科大学药学院) [摘要] 目的:填补国内对于城乡居民重大疾病总费用的测算空白和大病保险适宜保障模式分析的缺失。方法:在 典型重大疾病治疗总费用测算的基础上衡量我国罹患重大疾病的城乡居民的疾病负担。结果:随着医疗需求释放，罹患 重大疾病的城乡居民的医疗费用增长较快，在2020 年达到 38 1. 8 亿元。在不同的补偿方案下，到十三五期末，补偿金 额最高达到 373.2 亿元。结论:为保障医保基金持续稳定运营，需合理选择适合我国现阶段发展水平和补偿能力的大病 保险补偿方案，有效控制医疗费用增长，保障城乡居民多层次医疗需求。 [关键词] 大病保险;总费用测算;医保基金;补偿方案 [中图分类号] F 840.61 [文献标识码] A [文章编号] 1 ∞4-4663(2015 )08 -592 -05 Analyzing the compensation pattern for serious illn岱s iDSurance based on total cωt. / Cao Yang ,et al. / /The Chinese Health Service Management. Abstract Objective To improve the methods to measure the total cost of serious illness of urban and rural residents ,and de- velop 出e pattem for serious illness insurance. Methods Based on calculating the total cost of serious diseases ,burden of serious dis- eases on urban and rural residents was measured. Results With the increasing needs of medical services ,medical expenses of urban and rural residents suffering serious diseases increased rapidly. In different compensation schemes ,the amount of compensation will be up to 37. 32 billion Yuan till Thirteen Five-Year Plan . Conclusion To ensure the sustainable operation of health insurance fund ,reasonable compensation scheme for serious illness insurance needs to be chosen ,which should be suitable for China ,to effec- tively control healthcare cost and meet the multilevel needs of medical services of urban and rural residents. Authors address China Pharmaceutical University ,Nanjing ,P. R. China. Key word serious illness insurance; total cost estimation; health insurance fund; co