CAJ | 학술논문

青岛市以城镇基本医疗保险为基础,以医院、社区养老护理机构和家庭为载体,探索实施长期医疗护理保险制度,建立了完整的筹资、支付、经办、服务和监管等机制,设计较为科学的申报流程和报销流程,设定入住定点护理机构或养老机构享受长期护理、入住定点医院享受医疗专护和居家接受医疗照料的居家医疗护理3种服务方式,实行按每床日定额包干收费,报销比例分别为96％、90％、96％.经过1年多的实施,长期医疗护理保险制度切实减轻了患者的疾病负担,有力地引导长期医疗护理服务下沉社区,基本形成失能群体“医护康养”相结合的新型医疗服务体系.
청도시이성진기본의료보험위기출,이의원、사구양로호리궤구화가정위재체,탐색실시장기의료호리보험제도,건립료완정적주자、지부、경판、복무화감관등궤제,설계교위과학적신보류정화보소류정,설정입주정점호리궤구혹양로궤구향수장기호리、입주정점의원향수의료전호화거가접수의료조료적거가의료호리3충복무방식,실행안매상일정액포간수비,보소비례분별위96％、90％、96％.경과1년다적실시,장기의료호리보험제도절실감경료환자적질병부담,유력지인도장기의료호리복무하침사구,기본형성실능군체“의호강양”상결합적신형의료복무체계.
Based on the urban residents' basic medical insurance system in Qingdao,with hospitals,community aging care institutions and families as the carriers,Qingdao city explored and implemented the long-term medical care insurance system(LTMCI),and established mechanisms for fundraising,payment,handling,service and supervision.The city also designed a scientific application and reimbursement process.Three service modes are designed and put into practice as follows:Long-term care in designated nursing homes or pension institutions; Medical care at designated hospitals; and home health care.These services are charged by quota-lump per bed per day,with the reimbursement ratio of 96％,90％ and 96％ respectively.A practice over a year proved the LTMCI as effectively alleviating disease burden of patients,and guiding long-term care to serve communities.This way a new type of medical care system comes into being,with "medicine-care-recovery-endowment" for disabled population.