城乡基本医疗保障制度衔接的可行性分析:以武汉市洪山区为例  

Feasibility Analysis of Urban and Rural Basic Medical Insurance System Integration:Taking HongShan in Wuhan as an Example

作　　者：程岘[1] 刘博[1] 程茂金[2] 梁渊[2] 

机构地区：[1]华中科技大学同济医学院第二临床学院,武汉430030 [2]华中科技大学同济医学院公共卫生学院,武汉430030

出　　处：《医学与社会》2012年第8期65-68,共4页Medicine and Society

摘　　要：目的:以武汉市洪山区为例,分析城乡基本医疗保障制度衔接的可行性。方法:对两种医保制度的相关政策文件进行归纳整理,综合比较。结果:两种制度的最终目标都是建立全民医保;基本原则都是要求多制度协调发展,自愿参加保险,采用收支平衡和以收定支、财政专户和专款专用的方法管理资金;参保对象都是无工作单位的非从业者,且在同一个统筹县区内,收入及生活水平相差不大;筹资模式都是个人缴费与政府补助相结合,且政府承担主要责任;报销待遇都是大病医疗为主,住院按医疗机构的三级转诊制度逐级报销,且报销比例逐级下降。结论:制度衔接在政策制定、社会效益、财政支持方面具有可行性。可以通过统一统筹范围、扩大参保对象和建立多层次标准等办法让两种制度更好地衔接。Objective： Illustrated by the case of District Hongshang, Wuhan, this article analyses the possibility of urban and rural basic medical security systems. Methods： Organizing the policy documents of two systems, we compare with the differences of two systems. Results： The ultimate aims of two systems are the establishment of universal health insurance; their basic principles are the balance development of various systems, the voluntary medical insurance and the funds management of maintaining a balance between receipts and payments and earmarking a fund for its specified purpose only; their insured people are un-business residents ,without workplaces, whose income are similar in the same administrative area; their financing models are individual contributions combined with government subsidies which take most of the financing responsibility; their reimbursement systems mainly aim at high expense diseases,which grade and descend gradually in accordance with the 3-grade system of medical institutions. Conclusion： Policy-making, social benefit and financial resources provide the basic of possibility of the link-up between two systems. In order to make a better link-up, we can try to unify the administrative areas, extend the range of insured people and establish multilevel standards.

关 键 词：城乡基本医疗保障制度 新型农村合作医疗 城镇居民基本医疗保险 

分 类 号：R197.1[医药卫生—卫生事业管理]