名山区医保城乡统筹对居民就医及医保补偿的影响状况研究  

Studying on The Influence of Integration of Urban and Rural Medical Insurance on The Medical Services and Compensation for Urban and Rural Residents in Mingshan District

作　　者：程建平 杨松 彭美华[2] Cheng Jianping

机构地区：[1]名山区人民医院,四川雅安625100 [2]成都中医药大学管理学院

出　　处：《中国卫生事业管理》2021年第5期348-351,共4页Chinese Health Service Management

基　　金：四川省哲社重点研究基地西南减贫与发展研究中心一般项目“大病保险抑制疾病贫困的作用机制研究”(SCP1605);教育部一般项目“云贵川未成年人患者生活质量调查及卫生政策”(17YJC840027)。

摘　　要：目的通过分析名山区"两保"整合前后医保政策、居民就医趋势以及基金流向变化,为合理引导居民就医及提高基层医疗机构医保基金使用效率提出建议。方法利用卫生统计年鉴及医保年终结算数据进行描述性统计分析,结合管理者访谈。结果整合后名山区医保政策得到优化并更为严苛,县域内住院人次明显下滑,基层医疗机构就诊人次减少,医保基金使用效率降低。结论加强医疗合作与帮扶,政策落实与医保人才建设,提升基层医疗机构服务能力和保障水平;医保政策适度创新,满足群众就医需求;强化医保部门监管能力,确保政策执行。Objective To analyze the change of health insurance policy,the trend of residents’seeking medical care and the fund flow before and after the integration of"two insurances"in Mingshan District,and put forward some suggestions for improving it.Methods Descriptive statistical analysis was carried out on data of health statistical yearbook and year-end medical insurance settlement,combined with interview of managers.Results After the integration,the policy of medical insurance in Mingshan District has been optimized and were stricter.The person-time of inpatients in the county has decreased significantly.The person-time of visiting primary medical institutions has decreased.And the efficiency of medical insurance fund utilization has decreased.Conclusion It is suggested to strengthen medical cooperation,assistance and talent cultivation,improve the service and guarantee ability of grassroots medical institutions,innovate the policy to satisfy the people’s medical requirement,and intensify the supervision.

关 键 词：“两保”整合 城乡居民就医 城乡医保制度 名山区 

分 类 号：R197.1[医药卫生—卫生事业管理]