摘要目的:探讨我国部分地区基本医疗保险的差异化门诊报销政策对成人血友病A患者治疗水平与医疗费用的影响。方法:系统梳理与比较5个城市(NB、XM、TJ、SY和ZZ)的血友病A门诊报销政策，回顾性收集5个城市2018年成人血友病A患者基本特征、凝血因子处方用量以及医疗费用，探讨门诊报销政策差异对患者治疗水平与医疗费用的影响，并分析按需治疗和预防治疗患者的医疗费用差异。结果:不同地区门诊报销政策差异较大，NB医保待遇最好，主要体现在报销比例高，城镇职工报销金额不设封顶线，可衔接大病保险；XM和TJ相对较好，SY和ZZ较不理想。患者享受的报销待遇受其参保类型影响，ZZ和SY多为城乡居民基本医疗保险参保者，其医保待遇相对较差。就治疗水平而言，NB患者接受预防治疗的比例最高(21例，72.4%)，其次为XM(8例，26.7%)、TJ(10例，20.0%)、SY(5例，10.2%)，ZZ无患者接受预防治疗。门诊报销政策好的地区也相应伴随着较高的门诊治疗费用，且各城市预防治疗组费用均显著高于按需治疗组。结论:目前我国部分地区血友病A患者门诊报销待遇存在明显差异，患者接受治疗的规范性受各地医保报销水平的影响较大；报销待遇的提升会显著提升患者治疗水平，同时也伴随着更高的医疗费用，预防治疗组费用高于按需治疗组。建议进一步缩小各地报销水平的差异，同时采用衔接大病保险等方式提高患者治疗水平，降低血友病A患者负担。

abstractsObjective:To explore the influence of differentiated outpatient reimbursement policies of basic medical insurance in some areas of China on the treatment level and medical expenses of adult hemophilia A patients.Methods:The outpatient reimbursement policies of hemophilia A in 5 cities(NB, XM, TJ, SY and ZZ)were systematically reviewed and compared. The basic characteristics, dosage of coagulation factors and medical expenses of hemophilia A patients in the 5 cities in 2018 were collected retrospectively to explore the influence of outpatient reimbursement policy on the treatment level and medical expenses of patients, and the differences of medical expenses between on-demand treatment and prophylaxis treatment were analyzed.Results:The reimbursement policies for hemophilia A outpatients in different regions were quite different. NB medical insurance had the best treatment, mainly reflected in the high reimbursement rate, no capping line(only urban employee medical insurance), and could be connected with major illness insurance; XM and TJ were relatively good, SY and ZZ were not ideal. The level of reimbursement of patients was also affected by their types of insurance. Adult patients of ZZ and SY were mostly covered by basic medical insurance for urban and rural residents, and their medical insurance benefits were relatively poor. In terms of treatment level, NB patients received the highest proportion of prophylaxis treatment(21 cases, 72.4%), followed by XM(8 cases, 26.7%), TJ(10 cases, 20.0%), and SY(5 cases, 10.2%), and no patients in ZZ received prophylaxis treatment. The areas with good reimbursement policy for outpatients were also accompanied by higher treatment costs, and the costs of prophylaxis treatment groups in each city were higher than those of the on-demand treatment group.Conclusions:At present, there are obvious differences in outpatient reimbursement treatment of hemophilia A patients in some areas of China. The standardization of patients receiving treatment is greatly affected by the level of medical insurance reimbursement. The improvement of reimbursement treatment will significantly improve the treatment level of patients, and also accompanied with higher medical expenses. The expenses of prophylaxis treatment group are higher than those of on-demand treatment group. It is suggested to further narrow the differences of reimbursement levels in different regions, and to improve the treatment level of patients with severe illness insurance, so as to reduce the burden of hemophilia A patients.