城乡居民医保制度整合后的成效、问题及对策  

The Effects,Problems and Countermeasures of the Integrated Medical Insurance System for Urban and Rural Residents

作　　者：向运华[1] 曾飘 XIANG Yunhua;ZENG Piao

机构地区：[1]武汉大学社会保障研究中心,湖北武汉430072

出　　处：《决策与信息》2020年第4期53-60,共8页Decision & Information

摘　　要：城乡居民医保制度整合是近10年我国基本医疗保险改革中的关键一步。各省市积极出台整合办法进行落实,城乡居民医保整合工作整体进展良好:清退了重复参保人员;医保基金抗风险能力提升;提高了农村居民医疗保障水平;定点医疗机构统一管理;理顺了城乡居民医保管理体制。但是,整合后依然存在省市间统筹进度不一;部分地区分档缴费损害公平;居民医疗保险基金支出增长过快;城乡居民医保与职工医保间衔接不畅通等问题。为进一步完善城乡居民医疗保险,建议提高政策统筹层次;探索缴费与居民收入相挂钩的缴费机制;控制医疗保险基金支出风险;做好职工医保和城乡居民医保的联动工作。The integration of urban and rural residents'medical insurance system is a key step in the reform of basic medical insurance in China in the past ten years,the provinces and cities have actively introduced integrated measures to implement,and the overall progress of urban and rural residents'medical insurance integration is well made:the clearance of the persons that participates insurance repeatedly;the ability of the medical insurance fund to resist risks has been improved;medical security for rural residents has been improved;the designated medical institutions has been uniformly managed;the management system for medical insurance for urban and rural residents has been straightened out.However,after the integration,there are still some difficult problems:Progress in co-ordination between provinces and cities is different,the division of contributions in some parts damages fairness,residents'medical insurance fund expenditure rises too fast,urban and rural residents'medical insurance and workers'health insurance link is not smooth.To further improve the medical insurance for urban and rural residents,the countermeasures are put forward:to improve the level of policy co-ordination,to explore the payment mechanism linked to the income of residents,to control the risk of expenditure of medical insurance fund,and to do a good job in the linkage between the medical insurance for workers and the medical insurance for urban and rural residents.

关 键 词：城镇居民医保 新农合 城乡居民医保制度 

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]