浙江省全民基本医疗保险受益及补偿待遇均等化研究  

Study on Equalization of the Basic Medical Insurance Benefits and Compensation in Zhejiang

作　　者：王小合[1] 谷雨[1] 钱宇[1] 张萌[1] 黄仙红[1] 顾亚明 张亮[3] 

机构地区：[1]杭州师范大学医学院卫生事业管理系,杭州310036 [2]浙江省卫生和计划生育委员会,杭州310006 [3]华中科技大学医药卫生管理学院,武汉430030

出　　处：《中国卫生经济》2016年第3期43-48,共6页Chinese Health Economics

基　　金：国家自然科学基金项目(71273080);浙江省社科规划课题(12JCSH05YB);浙江省医药卫生科技计划项目(2011KYA125)

摘　　要：目的:定量评价浙江省全民基本医疗保险受益与补偿及均等化水平,探讨其均等化问题及改进策略。方法:选取东部经济活跃和发达的浙江省为典型研究现场,釆集2008—2012年该省6个不同经济类型市(县)所在统筹地区城乡基本医疗保险住院受益及补偿的数据资料,运用平均系数、差异系数、泰尔指数和基尼系数法,综合测评其均等化程度及趋势。结果:近5年来,各统筹地区间基本医保间、基本医保内及总体住院受益与补偿水平及均等化程度均呈现不断优化提高的发展态势,但实际住院补偿比及均次住院补偿费用尚未达到底线均等水平。2012年基本医保间均次住院补偿费用差异对总体差异的贡献率为84.999%。结论:实现全民享有均等化发展的实际补偿待遇应是当前城乡基本医保统筹发展的主要观测点。相比基本医保内各统筹地区间实际补偿待遇差异的逐年减小,基本医保的不均等实际待遇的差距仍然较大。建议该省深入探究全民基本医保筹资均等化现状及预测发展趋势,为其实际补偿待遇均等化提供基础性保障条件。Objective：To conduct quantitative evaluation on the benefits and compensation equalization degree of basic medical insurance in Zhejiang,discuss the equalization problem and improvement strategies.Methods：Choosing Zhejiang,the eastern prov.ince with well developed economics,as the typical research field.The 2008—2012 data of rural and urban basic medical insurance hospitalization benefits and compensation in 6 different typed pooling regions in Zhejiang were collected to comprehensively evaluate the equalization degree and trends based on uniformity coefficient,Theil index and Gini coefficient.Results：In last 5 years,the hos.pitalization benefits,compensation level and equalization degree under the basic medical insurance in different pooling regions all showed the constant optimizing and promoting development,but the practical hospitalization compensation ratio and average hospital.ization compensation cost per time did not reach the equal level of baseline.In 2012,the average basic medical insurance hospital.ization compensation cost difference per time had 84.999% contribution rate of the overall difference.Conclusion：Realizing the prac.tical reimbursement differences of equalization development for the whole residents was the main fixed points in the pooling develop.ment of current urban-rural basic medical insurance.While the practical reimbursement difference in different pooling regions under the medical insurance decreased by years,the differences of unequal practical treatment under the basic medical insurances were still large.It suggested to deeply explore the current equalization status and prediction development trend of resident basic medical in.surance,so as to provide fundamental security condition for practical reimbursement equalization.

关 键 词：基本医疗保险 住院受益 住院补偿 均等化 浙江 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]