医保制度运行的关键节点问题综合评价研究

发布时间：2018-08-23 09:39

【摘要】：目的:明确医保制度运行的突出问题,分析问题背后深层次的根源,为政策制定者提供决策的依据。方法:运用文献研究、现场调查和专家小组的方法进行问卷的调查,并采用TOPSIS综合评价法对我国医保制度运行的问题进行综合评价。结果:我国医保制度运行的6大突出问题排序为基金筹集相关问题(C_i=0.722)、基金运行和管理(C_i=0.634)、经济保护能力(C_i=0.471)、监督运行机制(C_i=0.388)、卫生服务利用公平性(C_i=0.374)和管理制度问题(C_i=0.347)。结论:大力推进城乡居民的医保制度筹资机制,实现从定额筹资到按可支配收入为基数筹资的过渡,通过控制医疗费用不合理的增长来保障基金的收支平衡,提高医保的统筹层次以及大病医保政策的有效推动等一揽子方案是医保制度运行问题的根本解决措施。
[Abstract]:Objective: to clarify the prominent problems in the operation of medical insurance system, analyze the underlying causes of the problems, and provide the basis for policy-makers to make decisions. Methods: the methods of literature research, field investigation and expert group were used to investigate the questionnaire, and the comprehensive evaluation method of TOPSIS was used to evaluate the operation of medical insurance system in China. Results: the six prominent problems in the operation of medical insurance system in China were fund raising related problems (C_i=0.722), fund operation and management (C_i=0.634), economic protection ability (C_i=0.471), supervision mechanism (C_i=0.388), health service utilization equity (C_i=0.374) and management system problem (C_i=0.347). Conclusion: promote the financing mechanism of urban and rural residents' medical insurance system, realize the transition from quota financing to disposable income financing, and ensure the balance of income and expenditure of the fund by controlling the unreasonable growth of medical expenses. Improving the overall level of medical insurance and the effective promotion of medical insurance policy are the fundamental measures to solve the operational problems of medical insurance system.
【作者单位】：哈尔滨医科大学卫生管理学院;宁波大学医学院预防医学教研室;
【基金】：国家自然科学基金项目(71333003,71573068) 教育部人文社科基金项目(14YJC630046)
【分类号】：F842.684;R197.1

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