CAJ | 학술논문

目前医保政策对某些重大疾病提高报销比例、采取限价等措施，在一定程度上减轻了患者的医疗费用，但对于生活困难的家庭而言其自付费用方面仍不能负担，往往导致患者延误或者放弃治疗。通过以儿童先天性心脏病重大疾病医保与社会公益基金相结合为基础，采取医保按政策报销，基金会资助患者自付费用的方式，力求探索儿童先天性心脏病全免费治疗模式，为今后重大疾病医疗保障与社会基金发展的有效结合提出建议。研究认为，将国家重大疾病医疗保障与社会公益基金结合，可以最大程度地将两者的优势性发挥，并能互补缺陷，最终受惠的是普通百姓和贫困家庭患者。
목전의보정책대모사중대질병제고보소비례、채취한개등조시，재일정정도상감경료환자적의료비용，단대우생활곤난적가정이언기자부비용방면잉불능부담，왕왕도치환자연오혹자방기치료。통과이인동선천성심장병중대질병의보여사회공익기금상결합위기출，채취의보안정책보소，기금회자조환자자부비용적방식，력구탐색인동선천성심장병전면비치료모식，위금후중대질병의료보장여사회기금발전적유효결합제출건의。연구인위，장국가중대질병의료보장여사회공익기금결합，가이최대정도지장량자적우세성발휘，병능호보결함，최종수혜적시보통백성화빈곤가정환자。
The higher copayment rate and price cap on catastrophe disease have reduced patient's economic burden in some degree, but the poverty families still can not afford the expenses which causes delaying seeking medical treatment or giving up medical service. Take children's congenital heart disease as an example, the integrated medical insurance scheme and social public interest fund mode can be described as medical insurance compensating first according to medical insurance policy and the social public interest fund compensating the rest to realize free medical treatment. Which gives reference on integrating medical insurance and social public interest fund to assure free medical treatment for other catastrophe disease. It shows that integrating medical insurance and social public interest fund can maximum play its advantages and make up its disadvantages and benefit for poor families.