A Study on the Impact of the Employee Medical Insurance Outpatient Mutual Assistance System on Medical Insurance Costs for Patients with Diabetes Mellitus
- VernacularTitle:职工医保门诊共济制度对糖尿病患者医保费用的影响研究
- Author:
Meng'en CHEN
1
;
Xiaoxi ZHANG
;
Youshu YUAN
;
Yan WANG
;
Tianzhen CONG
;
Haojia HOU
;
Jingyu YANG
;
Zhiwei WANG
Author Information
1. 北京中医药大学管理学院 北京 102400
- Publication Type:Journal Article
- Keywords:
employee medical insurance outpatient mutual assistance;
diabetes mellitus;
medical insurance costs
- From:
Chinese Health Economics
2025;44(10):38-42
- CountryChina
- Language:Chinese
-
Abstract:
Objective:It aims to examine the effects of the employee medical insurance outpatient mutual assistance on medical insurance costs for patients with diabetes mellitus,offering insights for optimizing outpatient insurance policies and chronic disease management strategies.Methods:Outpatient cost settlement data of urban employees with diabetes mellitus in Lanzhou from 2022 to 2023 was collected.Univariate analysis and interrupted time-series models were used to compare relevant medical insurance cost indicators before and after the reform.Results:The inpatient data of 765 730 diabetes mellitus patients were included in the study,and male patients account for 62.67％.After the reform,average per-visit pooling fund expenditure,average per-visit individual payment expenditures,average per-visit personal account expenditure,average per-visit eligible expense amount,average per-visit total fund payment,and the average per-visit proportion of basic medical pooling payments were decreased(P＜0.05).Moreover,average per-visit pooling fund expenditure,average per-visit individual account expenditure,average per-visit cash payment,average per-visit eligible expense amount,average per-visit total fund payment,and the average per-visit proportion of basic medical pooling payments showed a notable declining trend post-reform(P＜0.05).In contrast,the per-visit fully out-of-pocket expenditure exhibited no significant change before and after the reform(P＞0.05).Conclusion:The reform of the employee medical insurance outpatient mutual assistance system has alleviated the economic burden of disease for diabetic patients and improved the efficiency of medical insurance fund utilization,but it reduced the proportion of basic medical pooling payments.It is recommended to continuously refine the outpatient medical insurance payment system,strengthen supervision of medical expenses and service quality,and balance patient benefits with fund pressure to enhance chronic disease outpatient benefits.
