地方政府城镇职工医疗保险门诊共济政策比较及其优化研究  

Comparison and Optimization of Outpatient Mutual Aid Policies in Local Government Employee Medical Insurance

作　　者：胡思琦 黎嘉宏 HU Siqi;LI Jiahong

机构地区：[1]广西师范大学政治与公共管理学院,广西桂林541006

出　　处：《保险职业学院学报》2023年第6期10-15,共6页Journal of Insurance Professional College

基　　金：2021年广西地方法治与地方治理研究中心研究课题“乡村振兴战略背景下广西农村高龄老人养老难题与优化路径研究”项目编号:GXFZY202102。

摘　　要：本研究从差异性视角出发,对全国31个省(区、市)出台的医疗保险门诊共济政策进行比较,并探究地方政府城镇职工医疗保险门诊共济政策的优化路径。研究发现,目前门诊共济政策的实施存在省际慢特病管理标准模糊、退休职工个人账户计入方法不统一、医保个人账户使用范围差异较大以及统筹保障水平参差不齐等问题。鉴于此,提出以下优化对策:统一门诊慢特病管理标准,促进医保待遇公平;统一退休职工个人账户计入,完善动态调整机制;统一规定医保个人账户使用范围,强化门诊共济政策的共济性;统一统筹保障水平,优化政策顶层设计。From the perspective of differences,this study compares the outpatient mutual aid policies of medical insurance issued by 31 provinces(autonomous regions and municipalities)in China,and explores the optimization path of the outpatient mutual aid policies of local governments for urban employees.It is found that the current implementation of the outpatient mutual aid policy has some problems,such as the vague management standards for chronic diseases between provinces,the inconsistent method of crediting the personal accounts of retired employees,the large differences in the scope of use of medical insurance personal accounts,and the uneven level of overall security.In view of this,the following optimization counter⁃measures are proposed:unify the management standards of outpatient chronic diseases and promote the fairness of medical insurance treatment;unify retirement employees’personal accounts and improve the dynamic ad⁃justment mechanism;unify the scope of use of medical insurance personal accounts to enhance the mutual aid of outpatient mutual aid policies;unify the level of overall planning and security,and optimize the top-level design of policies.

关 键 词：职工医保 医疗保险 个人账户 门诊共济政策 

分 类 号：F840.613[经济管理—保险]