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2012年以来,中国建立城乡居民大病保险制度,有效缓解了“因病致贫、因病返贫”的问题,减轻了大病患者个人自负医疗费用的家庭经济压力。2016年10月,我们采集了2013~2015年度在内蒙古包头市肿瘤医院治疗的新农合参保患者的就医数据,作为样本对当地农牧民大病发生分布和大病医疗费用进行统计分析。发现肺癌、乳腺癌、胃癌、宫颈癌、直肠癌、结肠癌、食道癌七种恶性肿瘤是常见多发重大疾病,重大疾病发生率增加、医疗服务价格上涨和政策目录外医疗费用占比提升是导致医疗费用增长的三大因素。建议政府有关部门加快推进重大疾病医疗信息化建设,为疾病预防、诊疗分析、健康产业发展提供强大的数据支撑;加强重大疾病预防知识普及教育,建立国民定期体检制度;切实控制医疗费用不合理增长,加快推进按临床路径、按病种付费支付方式的改革,有效控制过度医疗,降低目录外医疗费用占比,节约医保基金,减轻患者个人自负压力。
Since 2012, China has established a system of major illness insurance for urban and rural residents, effectively alleviating the problem of “causing poverty due to illness and returning to poverty” and alleviating the financial pressure on families suffering from serious illness at their own expense. In October 2016, we collected medical data of NRCMS insured patients who were treated in Baotou Tumor Hospital of Inner Mongolia during 2013 ~ 2015 as a sample to conduct statistical analysis on the distribution of serious illness and serious medical costs of local farmers and herdsmen. Seven kinds of malignant tumors of lung cancer, breast cancer, stomach cancer, cervical cancer, colorectal cancer, colon cancer and esophageal cancer were found to be common and multiple major diseases, the incidence of major diseases increased, the price of medical services rose and the proportion of medical expenses outside the policy catalog increased Three factors that increase medical expenses. It is suggested that relevant government departments should speed up the construction of medical informationization for major diseases so as to provide strong data support for disease prevention, diagnosis and treatment and health industry development; strengthen popularization of education on prevention of major diseases and establish a regular physical examination system for the people; and earnestly control the unreasonable increase in medical expenses , Speed up the reform according to the clinical pathway and paying by way of payment, effectively control over-medical treatment, reduce the proportion of out-of-pocket medical expenses, save the medical insurance fund and relieve the patient’s personal pressure on self-sufficiency.