山东省普惠型商业医疗保险保障罕见病现状分析OA

Objective To analyze the current status of inclusive commercial medical insurance's protection of orphan diseases in Shandong Province,and to explore the level and trend of inclusive commercial medical insurance's protection of orphan disease drugs.Methods The latest Huiminbao plans and their specific drug lists of various cities in Shandong Province were collected from the official public accounts,mini-programs of Huiminbao in different cities and the websites of medical security bureaus.Among them,Dezhou,Liaocheng,Zaozhuang,Rizhao,Tai'an,Heze and Weifang were the 2024 plans,while the other 9 cities were the 2025 plans.The participation conditions and orphan disease protection situations of each plan were compared and analyzed.This includes coverage objects,contribution standards,protection responsibilities for orphan diseases,and benefit levels,etc.Results Picc Property&Casualty is the lead underwriter of the 9 cities'People's Welfare Insurance,with the strongest underwriting capacity.The second one is China Life Insurance.The"People's Welfare Insurance"in all 16 cities is open to the basic medical insurance participants of their respective cities.Among them,Binzhou,Zibo,Linyi and Weifang cities also apply it to the new urban residents.The minimum payment amount in the 16 cities of Shandong Province is 10 yuan and the maximum is 149 yuan.The payment range in Zibo City is the largest.The deductible in all 16 cities of Shandong Province is 10 000 yuan or more,the reimbursement ratio is generally no less than 70%,and the annual report amount is between 300 000～500 000 yuan.Among them,only Laroni Enzyme concentrated Solution B Injection(commercial insurance number 16,coverage ratio 100%)is the only orphan drug that has achieved full coverage in all 16 cities of the province,with the widest coverage.The corresponding disease type is"mucopolysaccharidosis".Conclusion Universal commercial insurance in various cities of Shandong Province has played a supplementary medical role in orphan disease coverage,strengthening the supply of orphan drugs and reducing the medical burden.However,at present,orphan disease coverage has not been fully covered.It is necessary for the government,insurance companies and other parties to work together to further expand the quantity and types of orphan drug coverage and enhance the coverage capacity.