广西城镇职工基本医疗保险基金运行现况及优化路径研究  

Analysis on the operation status and optimization path of Guangxi urban employee basic medical insurance fund

作　　者：杨梦喆 杜洁 袁瑜琳 胡陈圆 任琴 YANG Mengzhe;DU Jie;YUAN Yulin;HU Chenyuan;REN Qin(Westa College,Southwest University,Chongqing 400715;School of Public Health,Shandong Second Medical University,Weifang 261053;School of Humanities and Social Sciences,Guangxi Medical University,Nanning 530021,China)

机构地区：[1]西南大学西塔学院,重庆400715 [2]山东第二医科大学公共卫生学院,山东潍坊261053 [3]广西医科大学人文社会科学学院,广西南宁530021

出　　处：《南京医科大学学报（社会科学版）》2024年第6期585-590,共6页Journal of Nanjing Medical University（Social Sciences）

基　　金：山东第二医科大学研究生科研创新基金“少数民族流动人口健康社会支持及优化路径研究”(2023YJSCX002)。

摘　　要：文章分析了广西城镇职工基本医疗保险基金运行现状及实施效果。结果表明,2018—2022年广西城镇职工医保基金运行整体向好,职工医保参保人数、基金收入和支出均保持稳定增长趋势,年均增长率分别为5.60%、13.44%和12.92%,医保待遇享受人次逐步回升,次均住院费用保持稳中有降,且医疗费用报销比例分级诊疗导向日益明显。需着力优化职工医保参保结构,扩大筹资来源,推进门诊共济保障制度稳步实施,提高基金使用效率,建立健全常态化监管机制,推动广西城镇职工基本医疗保险基金平稳、可持续运行。This study discusses the operation status and implementation effect of basic medical insurance fund for urban employees in Guangxi.The results show that from 2018 to 2022,the operation of the urban employee medical insurance fund in Guangxi is overall positive,the number of employee medical insurance participation,fund revenue and expenditure maintain a stable growth trend,with an average annual growth rate of 5.60%,13.44%and 12.92%,respectively.The number of people receiving treatment under medical insurance has gradually rebounded.The average hospitalization cost per visit steadily dropped,and the hierarchical medical treatment system has become increasingly evident in the proportion of medical expense reimbursement.In general,it is necessary to focus on optimizing the structure of employee medical insurance participation,expanding the funding sources,steadily promoting the outpatient mutual⁃aid mechanism,improving the efficiency of fund use,establishing and improving the regularized supervision mechanism.By implementing these measures,we aim to provide a reference basis for promoting the stable and sustainable operation of the basic medical insurance fund for urban employees in Guangxi.

关 键 词：城镇职工基本医疗保险基金 运行现况 优化路径 广西壮族自治区 

分 类 号：R197.1[医药卫生—卫生事业管理]