重大疾病医疗保障结合社会公益基金发展实现免费医疗的实践探索

摘要

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。%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.