职工医保门诊共济保障机制改革的问题及对策研究
Study on the Problems and Countermeasures in Reforming the Outpatient Co-payment Protection Mechanism of Basic Medical Insurance for Urban Workers Policy
刘鑫雨 1牛雨涵 1谈在祥2
作者信息
- 1. 徐州医科大学公共卫生学院 江苏 徐州 221004
- 2. 徐州医科大学公共卫生学院 江苏 徐州 221004;徐州医科大学附属医院 江苏 徐州 221006
- 折叠
摘要
建立健全城镇职工基本医疗保险门诊共济保障机制是我国深化医疗保障制度改革的重大民生工程之一,各统筹地区门诊共济机制落地实施过程伴随着门诊医疗资源挤兑、欺诈骗保行为多发、政府经济负担增大和群众接受度不高等风险,对此提出开源节流补齐资金缺口、三医联动构建医保格局、协同监管维护医保基金稳定、优化政策筹措、推进医保支付方式改革等建议.
Abstract
The process of establishing and improving the Employee Health Insurance Outpatient Co-payment Protection Mecha-nism is one of the major livelihood projects to deepen the reform of China's medical insurance system.The implementation of the mu-tual-aid mechanism for covering outpatient bills in each coordinating region is accompanied by the risks of squeezing outpatient medi-cal resources,the prevalence of fraud and deception,the increase of the government s economic burden and the lack of public ac-ceptance.In this regard,suggestions are made to improve the policy:open source and cut costs to make up for the shortage of funds,linkage of three medical institutions to build a medical security pattem,coordinated supervision to maintain the stability of medical insurance funds,and optimized policies to promote the reform of medical insurance payment methods.
关键词
城镇职工基本医疗保险/门诊统筹/共济保障Key words
basic medical insurance for urban workers/outpatient coordination/mutual-aid mechanism引用本文复制引用
基金项目
江苏省社会科学基金(23ZXZB018)
江苏省卫生应急研究所-徐州医科大学卫生应急救援研究中心项目(2022)(JSWSYJ-20220302)
出版年
2024
NETL
NSTL
万方数据