上海市儿童医疗保障制度发展历程与展望  

Development history and prospect of children s medical security system in Shanghai

作　　者：王力男[1] 王贺男 朱碧帆 陈多[1] WANG Li-nan;WANG He-nan;ZHU Bi-fan;CHEN Duo(Shanghai Health Development Research Center/Shanghai Health Information Center,Shanghai 200040,China;China National Health Development Research Center,Beijing 100044,China)

机构地区：[1]上海市卫生和健康发展研究中心/上海市医学科学技术情报研究所,上海200040 [2]国家卫生健康委卫生发展研究中心,北京100044

出　　处：《卫生软科学》2022年第10期3-8,共6页Soft Science of Health

基　　金：首都医科大学国家医疗保障研究院开放性课题(YB2019B01);上海市红十字事务中心委托课题(2020310046001996,2021310046001107)。

摘　　要：通过总结上海市儿童医疗保障的发展历程和“双保险”制度,系统检索上海市儿童医疗保障制度相关政策文件,基于不同文件在各阶段需解决的问题,开展政策梳理和分析。少儿居民医保和少儿住院互助基金作为上海市儿童医保的主体,两个制度保障对象、保障范围、筹资水平和给付水平等协同完善发展,有效促进上海市多层次儿童医疗保障体系构建。当前上海市儿童医疗保障制度存在生育率下滑,参保意愿不稳定;多部门管理,结算流程相对复杂;医疗费用增长快,可持续性面临挑战等问题,建议以人为本,完善多层次儿童医疗保障体系。By summarizing the development history of children s medical security and the“double insurance”system in Shanghai,the relevant policy documents of children s medical security system were systematically retrieved.The policies were sorted out and analyzed based on the problems that need to be solved in different stages of different documents.The children s residential insurance and children s hospitalization mutual fund are proposed as the main body of children s medical insurance in Shanghai.The two system have coordinated and improved the objects,scope,financing level and payment level,effectively promote the construction of a multi-level children s medical insurance in Shanghai.At present,Shanghai children s medical security system have the problems of declining fertility rates and unstable willingness to participate in insurance,multi-departmental management and relatively complicated settlement procedures,rapid growth in medical expenses and challenges of sustainability.Finally,it suggests that improve the multi-level children s medical security system based on people.

关 键 词：儿童医保 少儿居保 少儿住院互助基金 上海 

分 类 号：R197[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]