CAJ | 학술논문

目的探讨我国城镇高血压患者适宜的医疗保险就医管理模式,提高医疗保险经办机构的管理水平和管理质量.方法　采用结构式问卷对高血压患者进行问卷调查,对社区卫生服务中心和医疗保险管理中心的相关工作人员进行定性访谈.结果　高血压患者的就医流向主要集中在社区和三级医院;不同地区的高血压患者对现有医疗保险有不同程度的不满意,主要体现在报销手续繁琐、起付线高和报销水平低等方面.讨论试行高血压的单病种支付,实行按人头和病种的总额预付的支付方式;加强社区高血压管理,医疗保险相关政策向社区倾斜;加强各级医疗机构合作,建立和完善高血压患者的规范管理信息网络.
목적 탐토아국성진고혈압환자괄의적의료보험취의관리모식,제고의료보험경판궤구적관리수평화관리질량.방법　채용결구식문권대고혈압환자진행문권조사,대사구위생복무중심화의료보험관리중심적상관공작인원진행정성방담.결과　고혈압환자적취의류향주요집중재사구화삼급의원;불동지구적고혈압환자대현유의료보험유불동정도적불만의,주요체현재보소수속번쇄、기부선고화보소수평저등방면.토론시행고혈압적단병충지부,실행안인두화병충적총액예부적지부방식;가강사구고혈압관리,의료보험상관정책향사구경사;가강각급의료궤구합작,건립화완선고혈압환자적규범관리신식망락.
Objective To probe into a doctor-seeking medical management model for China's urban hypertension patients under medical insurance, and enhance the level and quality of medical insurance management. Methods Hypertension patients were surveyed with a structured questionnaire, and the staff at community health centers and medical insurance management centers received qualitative interview. Results The hypertension patients are found to see doctors mostly at community health centers and tertiary hospitals; complaints among hypertension patients for existing medical insurance vary with their areas, mostly targeting on complicated reimbursement procedure, high threshold of medical insurance payment and low level of reimbursement. Recommendation Experiment with the single-disease payment for hypertension, with the total prepayment in per capita and per disease; greater efforts in hypertension control in communities, with more favorable medical insurance policies for communities;elevated collaboration with medical institutions at all levels, and building and standardizing the management information network for hypertension patients.