Abstract: Background　China's local governments have been outsourcing critical illness insurance services for many years and it is urgent to evaluate the implementation effectiveness.Satisfaction is one of the important measurement aspects.However，domestic research about patients' satisfaction with such services is insufficient.Objective　To perform a comparative analysis of patients' satisfaction with critical illness insurance services delivered by different government outsourcing models and the associated factors，providing a reference for relevant government agencies to improve the implementation policies and strategies.Methods　Data were collected from the critically ill patients information database of T City，Hebei Province.By use of convenience sampling，813 cases who were included in the database from 2014—2016 were selected，and were given a telephone-based or WeChat survey for obtaining their satisfaction level with critical illness insurance services delivered by different government outsourcing models.Multiple linear regression analysis was used to analyze the associated factors for the satisfaction level.Results　Patients with critical illness insurance for working urban residents（CIIWUR）obtained lower mean total score of satisfaction with the insurance，lower mean scores of satisfaction with the standard for pooling funds for the insurance，and satisfaction with the reimbursement procedure，but higher mean score of satisfaction with the reimbursement ratio compared with those with critical illness insurance for urban and rural residents（CIIURR）（P<0.05）．Multiple linear regression analysis showed that mean monthly income and purchase of commercial critical illness insurance were associated with satisfaction with the standard for pooling funds for the insurance in patients with CIIWUR（P<0.05）；education level，awareness level of the critical illness insurance，and purchase of commercial critical illness insurance were associated with satisfaction with the reimbursement procedure in patients with CIIWUR（P<0.05）；mean monthly income and awareness level of the critical illness insurance were associated with satisfaction with the reimbursement ratio in patients with CIIWUR（P<0.05）；awareness level of the critical illness insurance and purchase of commercial critical illness insurance were associated with satisfaction with the CIIWUR services by the insurance company in patients with CIIWUR（P<0.05）．Mean monthly income was associated with satisfaction with the standard for pooling funds for the insurance in patients with CIIURR（P<0.05）；purchase of commercial critical illness insurance and hospitalization due to illness or injury in the past year were associated with satisfaction with the reimbursement procedure in patients with CIIURR（P<0.05）；age，mean monthly income，purchase of commercial critical illness insurance and hospitalization due to illness or injury in the past year were associated with satisfaction with the reimbursement ratio in patients with CIIURR（P<0.05）．Conclusion　The reimbursement of critical illness insurance greatly contributes to patients' total satisfaction，but different outsourcing models of governments have different dimension satisfactions.In view of this，it is encouraged to share the advantages of the two government outsourcing models and to collaboratively overcome their limitations.Moreover，the increase of insured persons' satisfaction level should be listed as one of the value goals of the government outsourcing critical illness insurance services.

Key words: Insurance, long-term care；Patient satisfaction；Root cause analysis

摘要： 背景　政府外包大病医疗保险服务已实施多年，亟需评价其实施效果，满意度测量是其中一个重要方面，但目前关于其服务满意度的研究比较缺乏。目的　比较不同政府外包模式下大病医疗保险服务满意度，分析满意度影响因素，为相关部门改进和完善政策措施提供参考依据。方法　在T市2014—2016年大病患者信息数据库基础上，采取单纯随机抽样方法抽取813名患者作为调查对象，采用电话或微信访问收集其满意度信息。采用多元线性回归分析大病医疗保险满意度的影响因素。结果　城镇职工大病患者大病保险满意度总得分、筹资标准满意度得分、报销流程满意度得分低于城乡居民大病患者，补偿比例满意度得分高于城乡居民大病患者，差异有统计学意义（P<0.05）。多元线性回归分析的结果显示，月收入、购买商业重疾保险情况是城镇职工筹资标准满意度的影响因素，文化程度、大病医疗保险了解度、购买商业重疾保险情况是城镇职工大病保险报销流程满意度的影响因素，月收入、大病医疗保险了解度是城镇职工大病保险补偿比例满意度的影响因素，大病医疗保险了解度、购买商业重疾保险情况是城镇职工经办保险公司服务满意度的影响因素；月收入是城乡居民筹资标准满意度的影响因素，购买商业重疾保险情况、过去一年因病伤住院情况是城乡居民大病保险报销流程满意度的影响因素，年龄、月收入、购买商业重疾保险情况、过去一年因病伤住院情况是城乡居民大病保险补偿比例满意度的影响因素（P<0.05）。结论　大病医疗保险的补偿作用奠定了患者满意度的良好基础，不同政府外包模式不同维度满意度不同，实践中应促进两种外包模式取长补短，应针对满意度的影响因素，采取措施，将提高参保人满意度作为施行政府外包大病医疗保险服务的价值目标之一。

关键词: 保险, 长期医疗；病人满意度；影响因素分析