基本医疗保险省级统筹的障碍因素及推进建议——以山东省为例  

Obstacles and countermeasures to promote the provincial overall planning of basic medical insurance based on Shandong experience

作　　者：宋燕 程艳敏[1,2] SONG Yan;CHENG Yanmin(School of Healthcare Security,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan,Shandong 250117,China;Shandong Institute of Medicine and Health Information,Jinan,Shandong 250062,China)

机构地区：[1]山东第一医科大学(山东省医学科学院)医疗保障学院,山东济南250117 [2]山东省医药卫生科技信息研究所,山东济南250062

出　　处：《中国农村卫生事业管理》2022年第9期665-669,共5页Chinese Rural Health Service Administration

基　　金：山东省医疗保障局委托课题;山东第一医科大学学术提升计划项目(2019QL002)。

摘　　要：推进基本医疗保险省级统筹是当前我国基本医疗保险制度改革的重要内容之一。研究通过政策梳理、实证数据分析,综合评估了山东省基本医疗保险由市级统筹提高到省级统筹所面临的形势,探讨了推进基本医疗保险省级统筹的障碍因素,包括各市筹资待遇政策差异较大、区域卫生资源分布不均、各方主体利益诉求不同、经办管理体制难以适应,并以问题为导向提出相关推进建议,建议先行考虑调剂金模式,由区域统筹逐步过渡到省级统筹,并合理确定统一的医保征缴待遇标准,建立合适的医疗保险经办管理体制。Improving the overall planning level of medical insurance at provincial level is one of the important content of basic medical insurance system reform in China.Based on policy review and empirical data analysis,this paper explored the situation of basic medical insurance switching from municipal pooling to provincial pooling in Shandong province,and evaluated the core obstacles,including the regional differences in financing policy and health resources distribution,the uncoordinated interests of participants,as well as the mismatched service system.It is suggested that the provincial pooling should be gradually transferred from regional pooling and the mutual compensation model be considered first.Meanwhile,the unified financing and payment standard as well as appropriate medical insurance service system should be reasonably determined.

关 键 词：基本医疗保险 省级统筹 统筹层次 统筹模式 基金管理 障碍因素 

分 类 号：R197[医药卫生—卫生事业管理] F870.684[医药卫生—公共卫生与预防医学]