Pathways to regional coordination of medical insurance catalogs:The case of Zhejiang and Shanghai
10.3969/j.issn.1674-2982.2025.10.003
- VernacularTitle:区域医保目录协同路径研究:以浙江—上海为例
- Author:
Rui HUANG
1
;
Li LUO
;
Tian-tian ZHANG
;
Cheng MAO
Author Information
1. 复旦大学上海市重大传染病和生物安全研究院 上海 200032
- Publication Type:Journal Article
- Keywords:
Cross-regional medical treatment;
Medical insurance fund expenditure;
Regional coordinated development;
Catalog coordination
- From:
Chinese Journal of Health Policy
2025;18(10):19-23
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Under the framework of regional coordinated development,this study aims to construct a generalizable pathway for the coordination of medical insurance catalogs,providing methodological support for dynamic adjustment and fund impact estimation,thereby promoting convergence among regional catalogs.Methods:The medical insurance catalogs of the insured and treatment regions were systematically compared to identify discrepant items.Based on the National Healthcare Security Administration(NHSA)service coding system,a"treatment region-national-insured region"mapping process was established to standardize item correspondence and accurately calculate interregional service volumes.A static scenario simulation was then conducted,using the number of interregional hospitalizations as the core indicator to design multi-threshold inclusion schemes and estimate the resulting impacts on insurance fund expenditures.Results:Using Zhejiang and Shanghai as a case study,344 discrepant items were identified,with therapeutic services being predominant.When the inclusion threshold for interregional hospitalizations increased from 0 to 500 cases,the number of included items decreased from 244 to 36,while the additional insurance expenditure declined from 892 million to 322 million CNY.Conclusion:The proposed coordination pathway demonstrates both scientific rigor and operational feasibility.It is recommended that regions establish a demand-oriented dynamic adjustment mechanism,prioritize the inclusion of high-frequency and high-demand therapeutic items,and improve multi-tier insurance systems to systematically advance the integration of regional medical insurance.
