Objective To analyze the current status of health insurance policies for outpatient chronic diseases among urban and rural residents in Sichuan Province and provide policy recommendations for improving their management. Methods Health insurance policies for outpatient chronic diseases across 21 coordination districts in Sichuan Province were systematically reviewed by computer. Descriptive analysis was employed to compare differences in disease coverage, classification management, eligibility criteria, and benefit levels. Results In Sichuan Province, the number of outpatient chronic and special diseases across its 21 coordination areas ranged from 41 to 77. The coverage of these diseases varies included <10%, 10%–49%, 50%–99%, and 100%, and the diseases were managed under 2, 3, or 4 categories. There were also significant variations in disease recognition criteria and the level of benefit protection among the different coordination areas. Conclusions Significant disparities exist in outpatient chronic diseases policies and management practices among the 21 coordination districts in Sichuan Province. To address this, we recommend standardizing the provincial outpatient chronic diseases catalog, eligibility criteria, and classification management. Additionally, benefit levels should be optimized and regional disparities gradually reduced under the premise of maintaining balanced medical insurance fund risks.
Objective To compare the similarities and differences in the policy frameworks of outpatient chronic diseases and special critical diseases of urban employed basic medical insurance across 22 regions (including the provincial-level region) in Sichuan Province, and provide reference for promoting unified planning of basic medical insurance at the provincial level. Methods Policy documents and relevant materials related to outpatient chronic diseases and special critical diseases which were released as of December 31, 2024 were retrieved from the official websites of the Sichuan Provincial Medical Security Administration and those regions. A structured database was constructed, and content analysis was employed to compare regional policy variations in terms of disease coverage, identification and management criteria, and benefit levels. Results Considerable disparities were observed across regions in insured disease scope, identification management and benefit levels. The number of insured diseases ranged from 37 to 66, with a range of 29. While 14 diseases were covered by all regions, the identification criteria for the same diseases were inconsistent. Moreover, the deductible standards, reimbursement ratios, and reimbursement cap lines varied among regions. The deductible standards ranged from 0 to 1000 yuan, the reimbursement ratios ranged from 50% to 100%, and the cap lines ranged from 800 to 36000 yuan. Conclusions There are pronounced regional disparities in the benefit levels for outpatient chronic diseases and special critical diseases under Sichuan Province’s urban employed basic medical insurance scheme, raising concerns regarding horizontal equity. Given that benefit levels are influenced by regional economic development and the financial levels of insurance funds, it is recommended to gradually standardize the disease list and identification criteria at the provincial level, and to develop appropriate benefit policies to narrow regional gaps.
