| Objective Based on the evaluation of the implementation effect of policy of Catastrophic Disease Insurance Policy of New Rural Cooperative Medical Scheme in Sichuan Province from 2012 to 2015,this paper summarizes the effectiveness and problems of the policy of catastrophic disease insurance for rural residents,and then puts forward suggestions for the development of the policy under the background of integrating medical insurance for urban and rural residents.Methods Understanding the implementation of catastrophic disease insurance policy in different provinces by documentary analysis for providing reference on the study of this policy in Sichuan province;summarizing the implementation effect of sample area by interviewing method;analyzing the general situation of indicators,such as the disease coverage,benefit person,etc.of catastrophic disease insurance policy in Sichuan by descriptive statistical method.Results In 2012,the diseases coverage of the policy expanded to 21 kinds.In 2012-2015,the proportion of serious disease compensated by this policy in Sichuan Province increased continuously,with the largest number of beneficiaries in 2013 reaching 92,749,but the overall proportion was still small.From 2012 to 2015,the top five diseases of the number of suffering from serious disease and treated were severe mental illness,cerebral infarction,end-stage renal disease,lung cancer,esophageal cancer,AIDS-Related Opportunistic Infections.In the meantime,the proportion of serious disease compensation accounted for the total hospitalization reimbursement constantly increased,but the overall proportion was still smaller.Achieved the following results Firstly,it effectively improved the proportion of the actual reimbursement of patients with serious disease in rural areas of Sichuan Province,and reduced the medical burden of patients with major diseases.Secondly,it promoted the exploration of clinical pathway in some hospitals.Thirdly,DRGs promoted the payment reform.Lastly,the one-stop service of basic medical insurance system and medical assistance system was gradually carried out.Problems Firstly,it is limited that the type of diseases which could be compensated and less benefits within the scope of diseases.Secondly,the reimbursement level for residents suffering from serious disease is low,which does not meet the demands of diseases treatment.Thirdly,there are not clear reward and punishment measures,and there are major differences between different areas in the process of policy implementation.Fourthly,the complexity of diseases,the restrictions on the use of high-quality medical services,the low level of medical technology in hospitals,the low level of information technology are important factors restricting the management of clinical pathway.Fifthly,the information system of NCMS lags behind,and the function is not perfect,so,it is not suitable to policy.Suggestions Under the circumstances of the integrated medical insurance for urban and rural residents and the "13th Five-Year" Health Poverty Alleviation Policy,this paper put forward the following suggestions on policy development: Firstly,we should optimize the institutional cohesion of illnesses reimbursement,and broaden the channels of funding sources.Secondly,select disease of heavy burden and add them into payment reform.Thirdly,it is beneficial to develop differentiated payment standards and timely adjust it.Fourthly,we also could strengthen the application of the clinical pathway of serious disease by improving the level of medical technology in hospital,training professional researchers of clinical pathway,strengthening the information management of clinical pathway and so on.Fifthly,it is useful to establish the incentive mechanism of serious disease of case-based payment,and strengthen supervision and evaluation.Sixth point,it is good for meeting the policy needs to integrate and upgrade the information system of medical insurance,perfect the system function,improve the policy adaptability. |
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