Abstract
比较重庆市已纳入慢病管理系统2型糖尿病患者中，有、无特殊疾病医疗保险（简称特病医保）者之间的治疗费用情况及可能影响申请该特病医保的因素。
方法
采用结构化问卷，调查患者的基本信息及与糖尿病有关的药房、门诊、住院治疗费用情况。使用SAS 9.1软件进行数据统计分析，计数资料分析采用
2
检验，有统计学差异的变量再纳入多因素逐步logistic回归模型。连续性变量用中位数（四分位数间距）[
Q
）]来表示，采用Wilcoxon秩和检验。
门诊组有特病医保的患者年人均总费用[2160（3081）元]较无特病医保的患者高[1000（2100）元，
P
< 0.01]，年次均自费比例（54.04%）低于无特病医保患者的自费比例（93.78%，
P
< 0.01）。就申请特病医保而言，中等收入水平（
OR
=1.94）、高收入水平（
OR
=2.11）、参加城镇职工医疗保险（
OR
=4.19）、病程超过5年（
OR
=2.04）都是其可能的影响因素，具有这些特征的患者相对更容易申请到特病医保。
为缓解2型糖尿病患者经济负担，政府应大力宣传特病医保的相关政策，鼓励患者主动了解，积极申报。同时，医保部门与医疗机构应加强监管，简化办理流程，建议增加特殊疾病定点零售药店的数量和覆盖面，提高特病医保利用的可及性。同时，应更加关注低收入人群和病程相对较短的患者，增强他们抵御疾病经济风险的能力，提高特病医保的利用及公平性。
Abstract
Objective
To compare the treatment costs on type 2 diabetes between patients with and without specific diseases health insurance, and to identify the influencing factors related to specific diseases health insurance application.
Methods
A structured questionnaire was used to investigate basic information, diabetes-related pharmacy, outpatient and inpatient treatment costs. SAS9.1 software was used for statistical analysis. The enumeration data was analyzed by using Chi-square test, and variables of statistical difference were bought into Logistic regression model through stepwise method. Continuous variables were represented by median(inter-quartile range)[
M(Q
)], and were analyzed by using Wilcoxon test.
Results
Compared with patients without specific disease health insurance in outpatient group, patients with specific disease health insurance had higher annual per capita total cost [2160(3081)
vs
1000(2100) yuan,
P
< 0.01] and lower out-of-pocket expense ratio [54.04%
vs
93.78%,
P
< 0.01]. Patients with middle or high level income (
OR
=1.94 and 2.11), participated in urban employee basic medical insurance (
OR
=4.19) and duration of disease >5 years (
OR
=2.04) were more likely to succeed in specific diseases health insurance application.
Conclusion
To reduce the financial burden of patients with type 2 diabetes, government should make huge efforts to promote specific disease health insurance policies, and encourage patients to apply for it. Meanwhile, medical insurance department and medical institutions should reinforce supervision and simplify the application process. To improve the availability of specific disease health insurance, the number and coverage of designated retail pharmacies should be increased. Besides, government should pay more attention to low-income patients and those with short duration diabetes, so as to enhance their ability to resist economic risks and reflect the fairness of specific disease health insurance.
Keywords:
Diabetes mellitus, type 2/economics; Insurance, health; Health care costs; Fees, medical; Fees and charges/statistics & numerical data; Questionnaires; Regression analysis
特殊疾病是指那些患者需要长期甚至终身治疗与服药，治疗费及药品费都较一般疾病高的疾病
。它主要包括血友病、儿童先天性心脏病等13类重大疾病，同时也包括1型和2型糖尿病、高血压病、冠心病等10类慢性疾病。一般情况下，这些疾病门诊费用由个人账户支付，余额不足时由患者自付；住院费用由统筹基金支付。若患者申请到了特殊疾病医疗保险(简称特病医保)，在门诊接受诊疗时就由统筹基金支付一定比例的医疗费，这样可以较好地缓解患者长期治疗与服药的个人经济负担问题
。特病医保的申办方式是先由患者本人主动向区县医疗保险经办机构提出特殊疾病管理的申请，再由指定的医疗机构做出集中诊断，部分患者若未主动申请，则不能纳入特病医保的管理范畴
。2010年，重庆市10个区县慢病监测结果显示，18岁以上居民糖尿病患病率为9.5%(来源于2015年重庆市疾病预防控制中心《重庆市2014年慢性病及危险因素监测结果情况简报》)，接近同期全国糖尿病患病率9.7%
。糖尿病患者就经济负担而言，随时间推移呈缓慢上升趋势
。国外相关研究也表明，糖尿病患者经济负担较重。在芬兰，2010年2型糖尿病患者的个人年平均费用约1000欧元，约合7049元人民币
。据报道，法国政府一直专注于将一级预防作为国民营养与健康项目的一部分，2010年，在法国接受药物治疗的糖尿病患者年花费高达177亿欧元，其中约14.12%用于与糖尿病直接相关的治疗和预防
随着信息技术的不断发展，信息资源的开放共享，使用慢性非传染性疾病管理系统不仅提高了工作效率，避免重报或漏报，还有利于充分发挥各部门慢病防治职能，将更多的患者纳入管理范畴
。本研究选择了重庆市已纳入慢病管理系统的2型糖尿病患者，通过比较患者是否享受到特病医保，分析他们在医保定点药房、门诊及住院的糖尿病相关治疗费用及可能的影响因素，有利于比较不同医疗保险类型患者的经济负担情况，为合理利用卫生资源，控制患者自付费用增长提供参考。
