Objective To sort out the general out-patient coordination policies of basic health insurance for employee(BHIE)at the provincial level in China,and to provide references for further improving the out-patient coordination policies.Methods The policy docu-ments of out-patient coordination of BHIE issued by departments of provincial administrative regions in China from December 1998 to February 2024 were collected and analyzed from four dimensions of financing mechanism,deductible line,reimbursement ratio and capping line.Results By 2022,China had formed a nationwide layout of outpatient coordination policies and the vast majority of provinces had es-tablished and improved the outpatient coordination mechanism based on the way of"weakening individual health insurance accounts and strengthening pooling funds".The provinces had set a higher reimbursement ratio,but there were major differences in the deductible line and capping line.The benefit model could be divided into five types:exploration type,conservative type,welfare type,balanced type and flexible type.Conclusion The outpatient coordination policy has become the main method to guarantee the outpatient expenses of employee,which have multiple impacts on patients,health insurance department,hospitals and medicine.There is an urgent need to ensure the con-nection between outpatient coordination and personal account policies,promote the reform of the outpatient payment,strengthen the fund supervision,and further optimize the policy of the outpatient coordination of employee health insurance.
关键词
职工医保/门诊统筹/门诊共济/医保待遇/省际比较
Key words
employee health insurance/outpatient coordination/outpatient mutual-aid/medical insurance benefits/inter-provincial comparison
维普
万方数据