The Research Of Management Of Chronic Diseases In Medical Insurance Clinics Of Urban Employees In Nanjing

Background:At present,chronic diseases have replaced some traditional infectious diseases,The chronic diseases have been rising year by year in the spectrum of diseases and the cause of death.This has seriously threatened the healthy and sustainable development of human society.In China,the number of deaths due to chronic diseases accounts for 85% of the total deaths,and 45% of the chronically ill patients die before the age of 70.The death toll from cardiovascular and cerebrovascular diseases,cancer and chronic respiratory diseases accounted for 79.4% of all deaths.The chronic disease accounted for 68.6% of the burden of disease.It is an important cause of poverty caused by people's illness,which seriously affects social and economic development.Hypertension is the most common chronic disease.In 2002,the prevalence of hypertension among people over the age of 18 in China was 18.8%.In 2012,more than 260 million patients with chronic diseases were diagnosed in China.With the acceleration of the aging process,the operation of medical insurance funds has also exerted great pressure.Chronic diseases have become the number one health threat in China,adding to the burden on individuals and society.At present,the unified planning for the protection of chronic diseases in China has not yet been released,making the policy of outpatients with chronic diseases appear fragmented.The basic medical insurance in various parts of China provides varying degrees of protection for the outpatient medical needs of patients with chronic diseases.Nanjing has formed a chronic disease-oriented outpatient chronic disease policy and has a good representation.Objective: Through the analysis of the theoretical basis of chronic diseases policy of medical insurance outpatients,the study of standardized management of hypertension,the current status of the operation of chronic diseases policy in medical insurance clinics in Nanjing,and the satisfaction of medical insurance outpatients with hypertension,the problems in the practice of chronic diseases in medical insurance clinics in Nanjing were explored,make recommendations and measures to further improve the outpatient protection policy for chronic diseases.Methods:(1)Literature research: review relevant literature,collect relevant theoretical works and research results related to outpatient treatment systems,chronic diseases such as hypertension at home and abroad,collect relevant policies and regulations for the management of chronic diseases in outpatients in Nanjing,and establish the theoretical basis for research.(2)Questionnaire survey: Based on the review of relevant literature,combined with the actual situation of the management of chronic diseases and hypertension in the medical insurance clinic in Nanjing,and through several expert arguments to design the questionnaire.A cluster-based random sampling method was used to conduct face-to-face questionnaire surveys among 6 triple-A hospitals and 8 community hospitals suffering from hypertension stage II and above in Nanjing.The survey included the basic situation of the individual patient,the policy awareness of the chronic disease,and the degree of satisfaction with the clinic.After data collection was completed,data was recorded using Epidata 3.1 software,and descriptive analysis and factor analysis were performed using SPSS 18.0 software.Conclusions:(1)T The efficiency of protection is low,and the cost of chronic diseases rises too fast;from the data on the number of visits to medical institutions at all levels of chronic diseases in outpatients in Nanjing,the tertiary medical institutions are still the main places for outpatient visits for patients with chronic diseases.Nanjing has set different fund compensation standards for community hospitals and non-community hospitals.The logic for the formulation of this policy is unreasonable,which impairs the fairness of medical insurance.The cumbersome management of chronic diseases has brought challenges to the management of chronic diseases in medical insurance.(2)Outpatients with chronic diseases have lower awareness and satisfaction with policies.According to the survey results,the patients stated that 41.1%,38.0%,and 48.1% of the policies on the payment standards,the highest reimbursement rates,and the reimbursement rate for chronic diseases in the urban employees' medical insurance clinics were only less than 50%,indicating that the patients had hypertension,etc.Chronic disease outpatient policy awareness is not ideal.(3)Factor analysis results: Three common factors were extracted,namely fixed-point medical institution factors,medical insurance policies and management factors,and medical insurance promotion factors.The weights of the three common factors were 0.341,0.323,and 0.336,respectively.The score of medical insurance promotion factors is low,and patients are generally not satisfied with the promotion of medical insurance policies.The fixed-point medical institution factor is the factor that has the greatest influence on the satisfaction of outpatient chronic disease management,and its weight is 0.470.Respondents' satisfaction with the factors of fixed-point medical institutions was also high.The satisfaction scores of the six indicators involved in this factor all exceeded 4 points and were between “satisfied” and “very satisfied”.The range of outpatients with chronic diseases and satisfaction rate of reimbursement were high,and the policies were relatively reasonable.The satisfaction scores of the four indicators of medical insurance policy and management factors were all between 3 and 4 points,and they were between "general satisfaction" and "comparative satisfaction".Summary and recommendations: Through the analysis of the policy operation conditions of medical insurance outpatients in Nanjing and the satisfaction degree of medical insurance outpatients with hypertension,the following suggestions are proposed:(1)Pay attention to the health management of chronic diseases,strengthen the connection with public health,and promote the integration of chronic disease prevention and control.(2)Strengthen policy advocacy and improve patient awareness.Strengthen the policy of publicizing the slowness of medical insurance,expand the channels for the dissemination of policies,and improve the convenience of the people's access to policy information.(3)To refine the reimbursement methods for outpatient drugs and treatment items,and to reform payment policies.(4)Establish drug price management and designated hospital management systems based on negotiation mechanisms and agreement management.(5)Organically combine the health insurance outpatient protection policy with the family doctor signing service system.(6)Strengthen the national top-level design function,clarify the division of labor in the medical insurance management and the central local authority and responsibility.