摘要
目的了解门诊就诊者对慢性病和特种重大疾病(简称“慢特病”)报销政策的知晓情况以及报销困难的影响因素,为国家医保新政策宣传普及提供参考依据,提高医保政策的可及性。方法运用方便抽样的方法随机调查在某三甲医院门诊大厅挂号的门诊就诊者159名,采用自主设计的问卷对他们进行面对面的调查;访谈某三甲医院医保办工作人员及部分病人。结果调查的159名门诊就诊者对慢特病门诊报销新政策的总知晓率为47.3%,对“报销限额”“报销时间”“定点医院报销”“门槛费收取方式”和“是否有绑定医保卡”的知晓水平分别为26.4%、42.1%、50.3%、50.9%和67.9%;有47.3%的人因不了解报销政策和流程出现过报销困难或无法报销。访谈结果显示,门诊患者对医保报销政策和报销流程的知晓水平以及医生对医保政策的了解程度是影响门诊报销的主要因素。结论门诊就诊患者对慢特病门诊报销政策的知晓率较低,可能会影响医保新政的可及性;应将慢特病医保政策和报销流程纳入社区和医院慢病管理健康教育内容中。
Objective To understand the awareness of reimbursement policy and influencing factors for chronic and specialist major diseases among outpatients,so as to provide references for the dissemination of new medical insurance policies and improve the accessibility of medical insurance.Methods A total of 159 outpatients was been surveyed by questionnaires with convenient sampling method.Interview was made with the person in charge of the medical insurance office of a tertiary hospital.Results Among the 159 outpatients surveyed,the total awareness rate of the reimbursement policy for chronic and specialist major diseases was 47.3%;The awareness levels of“reimbursement limit”,“reimbursement time”,“designated hospital reimbursement”“charging threshold fee”and“whether there have bound medical insurance card”were 26.4%,42.1%,50.3%,50.9%and 67.9%respectively;47.3%of the people had difficulties or could not be reimbursed because they did not understand the reimbursement policies and processes.The interview results showed that the outpatient’s awareness of the medical insurance reimbursement policy and reimbursement process and the doctor’s understanding of the medical insurance policy were the main factors affecting the outpatient reimbursement.Conclusion The low awareness rate on reimbursement policy of chronic and specialist major diseases among outpatients can affect the accessibility of the new medical insurance policy.Therefore,the medical insurance policy and reimbursement process of chronic and specialist major diseases should be included in the health education content of chronic disease management in communities and hospitals.
作者
赵子笑
仲学锋
Zhao Zixiao;Zhong Xuefeng(Anhui Medical University,Hefei 230032,China)
出处
《健康教育与健康促进》
2021年第5期470-473,共4页
Health Education and Health Promotion
关键词
门诊就诊者
慢性病和特种重大疾病
医保政策
知晓率
Outpatients
Chronic and specialist major diseases
Medical insurance policies
Awareness
