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目的:对江苏省城镇职工、居民基本医疗保险补偿水平进行评价。方法:以灾难性卫生支出设定基本医疗保险的底线补偿比例,以参保人群住院费用实际受益情况设定实际补偿比例,以四分位法比较分析各统筹市底线补偿比例与实际补偿比例的差值。结果:以10%作为灾难性卫生支出的临界值,职工医保的补偿水平高于底线水平,居民医保的补偿水平则低于底线水平。结论:职工医保的补偿水平一定程度上缓解了参保人群因病致贫的经济压力,而居民医保的补偿水平有限,尚待进一步提高。
Objective: To evaluate the level of compensation for basic medical insurance for urban workers and residents in Jiangsu Province. Methods: To set the baseline compensation rate of basic medical insurance with catastrophic health expenditure, set the actual compensation proportion according to the actual benefit of inpatient expenses of insured population, and compare and analyze the compensation ratio of the bottom line and the actual compensation proportion by the quartile method Difference. Results: With 10% as the critical value of catastrophic health expenditure, the compensation level of employee health insurance is above the baseline level and the compensation level of residents’ health insurance is below the baseline level. Conclusion: The level of compensation for workers ’health insurance relieves the insured people’s economic pressure caused by illness to some extent, but the level of compensation for residents’ health insurance is limited and needs to be further improved.