我国基本医疗保险通过对计划经济时期以单位为依托的劳保制度的改革,建立了覆盖所有就业人群的城镇职工医疗保险,并在“低水平、广覆盖”原则下将保险人群扩大到农村居民和城镇居民,不断完善基本医疗保险的社会功能。在提高保险水平上,允许商业保险机构经办超出基本医疗保险范围并给患者带来较大经济负担的疾病保险业务,极大地激活了医疗保险市场。同时,为适应流动人口的就医需要,各地试点了多种异地就医结算模式,通过探索以总额预付制为主的支付方式改革,降低医疗保险基金的赤字风险。我国的基本医疗保险在取得巨大成绩的同时,出现了以下问题:医疗保险统筹层次低,服务碎片化现象严重,个人账户的功能不强,医疗保险期基金赤字风险增加,支付方与提供方的谈判机制缺失,医疗保险支付方式改革滞后。这些出现在制度和管理上的问题阻碍了我国全民医保目标的实现。因此,需要提高医保统筹层次,逐步消除城乡医保制度的二元结构,提高医疗保险待遇水平以及基本医保的公平性和吸引力,最终实现全民医保。在医疗费用控制上,通过支付方式改革,完善医疗服务市场,实行医保经办机构和公立医院管办分离、政企分开,建立医保与医疗服务价格谈判机制,在控费的基础上不断提高医疗服务质量,平衡供需双方利益,使社会基本医疗保险健康持续发展。
<<The basic medical insurance of our country established the employee insurance covering all employment population of medical insurance for urban workers through the reform the planned economy of the relying on company,holding on the principle of the “low level,wide coverage” the medicare population expanded to urban and rural residents’,and display the social function gradually. In improving the benefit of the medical insurance,permit the mechanical insurance agency to carry out the business beyond the basic medical insurance resulting the patients with heavier economic burden,which greatly activates the medical insurance market. At the same time,to meet the medical needs of the floating population,conduct the varied settlement account model immediately to access the medical care by the pilot,and explore the global budget payment reform to reduce the deficit of medical insurance fund. The basic medical insurance in China made great achievements while there are the following problems,because of the low level fund of the medical insurance,the service fragmentation is serious,personal account show the dysfunction in mutualaid,the medical insurance fund deficit risk increases,the negotiation mechanism miss between the payment party and the supplier’s party,the medical insurance payment reform lagging,all these existing in the institution and the management of the medical insurance impede the achievement of the national health insurance. Therefore,improving the fund level of medical insurance,and gradually eliminating the gap of the urban and rural medical insurance system,improving the benefit equity and appeal of medical insurance to achieve universal health care ultimately. In controlling medical expenses,through the medical payment reform to improve the medical service market,not only implement the government and medical insurance agencies,but also the separation the government and public hospital,the establishment of medical care and medical service price negotiation mechanism,in the control of the medical expenses while continuous improvement of medical service quality,balance interests between supply and payment,so that male the medical insurance sustainable development.
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