城乡居民基本医疗保险制度整合与完善

发布时间：2018-02-03 18:36

本文关键词： 医疗保险制度整合医疗卫生资源分级诊疗　出处：《西北农林科技大学学报(社会科学版)》2016年05期 　论文类型：期刊论文

【摘要】：整合城乡居民基本医疗保险制度是建立更加公平可持续的全民医保制度的必然要求和基础条件,是我国医保制度发展与完善的必经之路。虽然部分地区在整合中取得了一定的成就,但是仍存在诸多问题:政策的不明确导致管理体制混乱,医疗卫生资源配置不均衡导致整合后的不公平,待遇的"就高不就低"取向会对医保基金产生一定的压力,缴费方式的选取不慎会影响制度的可持续和社会的稳定,"两定"的整合和分级诊疗的不完善导致大医院的压力增加等问题。因此,需要理顺城乡居民基本医疗保险制度整合的管理体制,注重城乡居民医保基金的开源节流和保值增值,推进医疗卫生资源的合理配置,增强对同质医疗卫生资源的可及性,选择适合各地地情的缴费方式,实现制度的平稳过渡,加快分级诊疗的实施进度,减轻大医院的就医压力。
[Abstract]:Integrating the basic medical insurance system of urban and rural residents is the inevitable requirement and basic condition of establishing a more equitable and sustainable universal medical insurance system. Although some areas have made some achievements in the integration, there are still many problems: the unclear policy leads to the confusion of the management system. The unbalanced allocation of medical and health resources leads to the unfairness after integration, and the orientation of "high or low" will have a certain pressure on the health insurance fund. The selection of payment methods will affect the sustainability of the system and social stability. The integration of "two determinations" and the imperfect grading of diagnosis and treatment will lead to the increase of pressure in large hospitals and so on. It is necessary to straighten out the management system of the basic medical insurance system of urban and rural residents, pay attention to the increase of income and increase the value of health insurance fund, and promote the rational allocation of medical and health resources. To enhance the accessibility of homogeneous medical and health resources, to choose the appropriate payment method for local conditions, to realize the smooth transition of the system, to speed up the implementation of graded diagnosis and treatment, and to reduce the pressure of medical treatment in large hospitals.
【作者单位】：中国医疗保险研究会;中国海洋大学法政学院;
【基金】：国家自然科学基金重点项目(713300065)
【分类号】：F842.684
【正文快照】： 党的十八大和十八届三中全会都明确提出整合城乡居民基本医疗保险制度,该制度的整合是建立更加公平可持续的全民医保制度的必然要求和基础条件,是我国医保制度发展与完善的必经之路。截止到2015年3月底,在区域内全部实现整合的有重庆、天津、青海、广东、宁夏、山东、浙江、新

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