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王伟光
    男,汉族,1950年2月出生,山东海阳人。1967年11月参加工作,1972年11月加入中国共产党,博士研究生学... 详情>>
李 扬
    1951年9月出生,籍贯安徽,1981年、1984年、1989年分别于安徽大学、复旦大学、中国人民大学获经济学学... 详情>>
李培林
    男,山东济南人。博士,研究员,中国社会科学院副院长,中国社会学会副会长,中国社会科学院社会学研究所副所长。《社会... 详情>>

    北京市医疗保险发展评估研究报告

    摘要

    越来越复杂的医保管理,特别是针对医疗服务提供方的管理和监督,对于医保的管理监督能力提出了更高的要求。医保经办机构的专业化能力,亟须适应越来越精细化的医疗服务管理和支付制度改革的需要;专业的医疗保险监督执法队伍缺失,加上相关法律法规建设滞后,打击骗保欺诈的力度严重不足。

    以完善制度为基础,以提升管理为重点,以医药卫生改革为支撑,逐步建立制度公平、管理高效、三医协同、基金可持续的医疗保障体系。

    第一步,可在现行基本医疗保险制度框架内,将医疗护理的相关费用纳入政策报销范围,促进医疗护理服务向基层社区医疗服务机构和居家护理转移,以降低失能老年人长期住院带来的医疗资源和医保基金的浪费。第二步,单独建立具有社会保险性质的长期护理保险制度,成为一个新险种,实行强制参保、单独筹资,覆盖目前所有的城镇职工、城乡居民医保参保人群。

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    Abstract

    More and more complex health care management, especially for the management and supervision of the medical service provider, supervision and management for health care ability put forward higher requirements. The professional capacity of the insurance agencies must be adapted to the need for more and more refined medical service management and payment system reform. The lack of professional medical insurance supervision and enforcement team, coupled with the delay in construction of related laws and regulations, is severely inadequate in the fight against fraud.

    Based on the perfect system, to enhance the management as the key point, supported by medicine and health care reform, and gradually establish a system of fair, efficient management, 3 d collaborative, fund sustainable health care system.

    The first step, but in the current within the framework of basic medical insurance system, will be incorporated into the policy for reimbursement of medical care costs associated with the scope, promote health care services to grass-roots community health care services and home care, in order to reduce the disability, the elderly long-term hospitalization medical resources and waste of medical insurance fund. The second step, a separate set up long-term care insurance system with characteristics of social insurance, as a new danger to plant, subject to compulsory ginseng, individual financing, now cover all urban workers, urban and rural residents medical insurance ginseng protect people.

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    作者简介
    王宗凡:王宗凡,人社部社会保障研究所医疗保险室主任、副研究员。
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