我国提升基本医疗保险统筹层次的回顾与思考  

A review and reflection on improving the overall pooling level of basic medical insurance in China

作　　者：何丽 郭玉琳 谢慧玲[1] HE Li;GUO Yulin;XIE Huiling(School of Public Health,Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830011,China)

机构地区：[1]新疆医科大学公共卫生学院,新疆乌鲁木齐830011

出　　处：《中国农村卫生事业管理》2021年第8期539-542,共4页Chinese Rural Health Service Administration

基　　金：国家自然科学基金项目(71363056)。

摘　　要：查阅和整理我国提升基本医疗保险统筹层次的相关文献、文件,明确研究现状和政策背景,运用文献分析法梳理我国基本医疗保险及其统筹层次的进程与现状,为相关研究提供一定理论参考。据分析,我国虽已建立了世界上规模最大的基本医疗保障网,但其统筹层次存在较大的地域差距,且整体水平有待提高;风险调剂金模式和统收统支模式是我国目前最常用的统筹模式;在提升统筹层次过程中需解决好政策、筹资和支出三层面所引出的问题和挑战。面对我国基本医疗保险统筹层次较低、提升较难的现状,建议突破行政区划,创新推动地区制度整合、完善基金管理制度,优化筹资结构、加强医保队伍建设,提升基金监管水平。Referring to and sorting out the relevant literature and documents to enhance the overall pooling level of basic medical insurance in China,and clarifying the research status and policy background,we used literature analysis method to sort out the process and status quo of the basic medical insurance and its overall pooling level in China,so as to provide some theoretical references for the related research.It has been found out that although China has established the largest basic medical security network in the world,there is still a large regional gap among its pooling levels,and the overall level needs to be improved.Risk adjustment fund model and unified revenue and expenditure model are the most commonly used pooling model in China.In the process of upgrading the overall level,we need to solve the problems and challenges arising from the levels of policy,financing and expenditure.In the face of the low overall pooling level of basic medical insurance in China and its difficulties in upgrading,it is suggested to break through the administrative division,innovate and promote the integration of regional systems,perfect the fund management system,optimize the financing structure,strengthen the construction of medical insurance team,and raise the level of fund supervision.

关 键 词：基本医疗保险 统筹层次 统筹模式 基金管理 风险防控 文献分析 

分 类 号：R197.1[医药卫生—卫生事业管理] F840.684[医药卫生—公共卫生与预防医学]