本文選題：大病保險 + 醫(yī)保待遇��； 參考：《中國衛(wèi)生政策研究》2017年04期

【摘要】：目的:分析珠海市大病保險政策實施情況,評估大病保險政策對職工醫(yī)保和居民醫(yī)保人群待遇差異的影響。方法:采用珠海市2012年、2014年醫(yī)保患者的數(shù)據(jù),對大病保險待遇獲得情況進行描述性分析,采用邏輯回歸模型分析影響大病保險待遇獲得概率的因素,構建三重差分模型比較大病保險政策對職工醫(yī)保和居民醫(yī)保人群實際報銷比差距的影響。結果:大病保險政策向高年齡段、高醫(yī)療費用段、有慢性病的醫(yī)保人群傾斜;控制其他因素后,同一費用段患者中職工醫(yī)�；颊呦硎艽蟛”ｋU待遇的概率低于居民醫(yī)�；颊�,前者為后者的58.1%。高費用段患者享受大病保險補償后,盡管職工醫(yī)�；颊叩膶嶋H報銷比高于居民醫(yī)�；颊�,但二者的實際報銷比差距減小了3.2個百分點。結論:大病保險政策向高醫(yī)療費用段人群傾斜,提高了高醫(yī)療費用人群實際報銷比,減小了居民醫(yī)保人群和職工醫(yī)保人群待遇的差距,促進了醫(yī)療保障公平性。
[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.
【作者單位】： 沈陽藥科大學工商管理學院;人力資源與社會保障部社會保障研究所;珠海市人力資源和社會保障局;
【分類號】：F842.684;R197.1

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