农民工基本医疗保险异地转接的基金风险控制

发布时间：2018-12-13 13:23

【摘要】：农民工基本医疗保险异地转接的难点在于医保基金的风险控制。对于转出地而言,农民工基本医疗保险异地转接不仅减少了医保基金,而且破坏了基于自然人口结构的"大数法则";对于转入地而言,由于农民工之前工作时累积了疾病,在转入地就医将导致迁入地医保基金出险。对此,医保关系转出地应加大农民工医疗保险扩面和基金征缴力度,提高医疗保险统筹层次,控制医疗费用支出不合理增长;医保关系转入地则应建立健全医疗保险基金总额预算制度,鼓励商业保险参与农民工医疗保险,建立医保基金的风险预警制度。同时,应做好制度顶层设计,由中央政府建立农民工医疗保险异地转接中央调剂金、农民工医疗保险关系转移资金结算机构,以及转出地和转入地之间的农民工就医费用共担机制。
[Abstract]:The difficulty of transferring the basic medical insurance of migrant workers lies in the risk control of the medical insurance fund. As far as the transfer is concerned, the transfer of migrant workers' basic medical insurance not only reduces the health insurance fund, but also destroys the "law of large numbers" based on the natural population structure. For transfer, because migrant workers had accumulated illness during their previous work, seeking medical treatment in the transfer would lead to the insurance fund in the relocation area out of danger. In view of this, the relationship between medical insurance and health insurance should be expanded and fund collection should be strengthened, the overall level of medical insurance should be raised, and the unreasonable increase of medical expenses should be controlled. It is necessary to establish and perfect the budget system of medical insurance fund, encourage commercial insurance to participate in the medical insurance of migrant workers, and establish the risk warning system of medical insurance fund. At the same time, the top level design of the system should be done well, and the central government should establish a central adjustment fund for the transfer of medical insurance for migrant workers in different places, and a settlement organization for the transfer of funds for the medical insurance relationship of migrant workers. And the transfer and transfer between the migrant workers to share the costs of medical mechanisms.
【作者单位】：安徽财经大学财政与公共管理学院;首都经济贸易大学经济学院;
【基金】：国家社会科学基金“农民工基本医疗保险的异地转接研究”(13CGL102) 教育部人文社会科学基金“新型农村合作医疗与城镇居民基本医疗保险两制衔接研究”(12YJC790152) 中国博士后科学基金“新医改背景下城乡医疗保障一体化研究”(2012M510316);中国博士后科学基金特别资助项目“农村劳动力转移的健康选择机制研究”(2013T60058) 中国浦东干部学院“农民工医疗保险长三角区域内转移接续研究”(CELAP2014-YZD-20)
【分类号】：F842.684;F323.89

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