为进一步完善普通门诊统筹制度,为及时调整政策及管理方式提供科学依据,我们对普通门诊统筹政策进行回顾性分析。截至2010年6月30日,普通门诊统筹政策的实施暂未对基金运转构成压力,年终结余率达65%,实际上增加了医保统筹基金的总体结余;门诊统筹总体记账比例接近40%,一定程度上减轻了参保人门诊医疗费用负担,但仍未达到预期水平;政策实施未刺激医疗需求过度增长,但平均医疗费用增长速度较快;与定点医疗机构按人头限额结算方式实施平稳,但实际发生的年度人头费用过低;参保人就医仍集中在非基层医院,但已呈现向基层医院分流的趋势;社会对普通门诊统筹政策的总体满意度较高。
<<For purpose to provide scientific basis as to consummate the general out-patient’s pooling account (cost reimbursement) system and adjust policies and management methods in time. Such review has been carried out. Till June 30,2010,implementation of policy hasn’t carried so much pressure on fund operation. The year-end balance rate is 65%,which actually increase the balance of health insurance fund;outpatient cost reimbursement rate reaches nearly 40%,which has reduce the medical costs for insured patient,but have not yet reached the expected level;policy implementation does not stimulate excessive growth of medical needs,but the average health care cost increases faster;and the method of limited reimbursement per person through designated medical institutions carried smoothly,but the actual annual cost was at a low level;The insured person still concentrated to receive treatment in non-basic level hospital,yet showing a trend to concentrate in basic level hospital;the public overall satisfaction against our policy is high.
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