张掖市城乡居民医疗保险基金可持续发展研究  

Sustainable development of medical insurance fund for urban and rural residents in Zhangye city

作　　者：任雪琳 扎西卓玛 张莹 冯渤曦 王凌鸿 王学军 REN Xuelin;ZHAXI Zhuoma;ZHANG Ying;FENG Boxi;WANG Linghong;WANG Xuejun(School of Public Health,Gansu University of Traditional Chinese Medicine,Lanzhou,Gansu 730000,China;不详)

机构地区：[1]甘肃中医药大学公共卫生学院,甘肃兰州730000

出　　处：《中国农村卫生事业管理》2025年第1期54-59,共6页Chinese Rural Health Service Administration

基　　金：甘肃省自然科学基金重点项目(23jRRA1204)。

摘　　要：目的分析甘肃省张掖市城乡居民医保基金可持续发展情况,为该市及其他欠发达地区提升医保基金可持续运行能力提供参考。方法基于2018—2022年张掖市城乡居民医保基金运行数据,采用灰色预测模型GM(1,1)对2023—2030年医保基金收支进行预测并结合医保结算数据分析影响医保基金可持续发展的原因。结果2023—2030年各统筹地区医保基金收支发展不均衡,未来可能出现收不抵支的情况。原因在于居民预防意识差、慢性病治疗负担重及卫生资源配置不均衡。结论建议深化医保制度改革、探索医疗医保患者一体化管理模式、促进医疗优质资源、患者、基金三下沉、加强健康干预。Objective To analyze the sustainable development of the medical insurance fund for urban and rural residents in Zhangye city of Gansu Province,and to provide references for the city and other underdevel-oped areas to enhance the sustainable operation of the medical insurance fund.Methods Based on the operation data of the city’s medical inurance fund for urban and rural residents from 2018 to 2022,the gray prediction mod-el GM(1,1)was used to predict the income and expenditure of the medical insurance fund from 2023 to 2030 and analyze the causes affecting the sustainable development of the medical insurance fund in combination with the data analysis of medical insurance settlement.Results During the period of 2023—2030,the development of the income and expenditure of the medical insurance fund would be uneven among respective regions,and there might be a situation in which the income could not cover the expenditure.The causes involved were poor awareness of prevention among the population,the heavy burden of treating chronic diseases,and the unbalanced allocation of health resources.Conclusions It is suggested to deepen the reform of medical insurance system,explore the in-tegrated management model of medical and health insurance patients,promote the allocation of high-quality health resources,patients and funds to subordinate healthcare institutions,and strengthen health interventions.

关 键 词：城乡居民基本医疗保险 GM(1 1)灰色预测模型 医保基金 收支平衡 可持续发展 

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]