Analysis on the current status of outpatient benefit policies for patients with hypertension and diabetes in urban and rural residents
10.3969/j.issn.1674-2982.2025.02.004
- VernacularTitle:城乡居民"两病"门诊用药保障政策设定现状分析
- Author:
Pei-lin WU
1
;
Jing LIANG
;
Yan-qing MIAO
;
Dong-hua TIAN
Author Information
1. 北京师范大学政府管理学院 北京 100875
- Publication Type:Journal Article
- Keywords:
Hypertension;
Diabetes;
Outpatient benefit;
Policy design
- From:
Chinese Journal of Health Policy
2025;18(2):24-29
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the current policy design of outpatient benefit policies for patients with hypertension and diabetes(H&D)in urban and rural residents in China,and to provide references for optimizing the outpatient benefit mechanism for patients with H&D.Methods:A questionnaire survey was conducted to collect data on the basic features of General Outpatient Benefit(GOB),Outpatient Medication Guarantee Mechanisms for Hypertension and Diabetes(OMGM-H&D)and Outpatient Benefit for Patient with Chronic and Special Diseases(OB-C&S),focusing on deductibles,policy reimbursement ratios,and maximum payment limits.Descriptive statistical analysis was performed on the data.Results:A total of 334 regions were surveyed,of which 253 regions(75.34％)had implemented all three policies.Regional analysis revealed significant differences(P<0.001)in reimbursement ratios for GOB and the OMGM-H&D between the eastern,central,and western regions,with the western region having notably higher ratios than the eastern and central regions.However,no significant difference (P>0.05) was observed in the reimbursement ratios for OB-C&S across regions. Regarding deductibles,no significant regional difference (P>0.05) was found for GOB,but significant differences (P<0.05) existed for the OMGM-H&D and OB-C&S. Additionally,the annual maximum payment limits for all three policies showed significant regional variations (P<0.001). Conclusions:The outpatient benefits policy for patients with H&D have achieved full coverage nationwide among urban and rural residents in China,but regional equity in benefit levels requires improvement. It is recommended to strengthen data feedback mechanisms and promote provincial-level pooling of medical insurance.
