医疗保险统筹基金收支平衡影响因素及对策

Influential Factors of Balance between Income and Expenditure of Pooling funds of Basic Medical Insurance and Countermeasures

基本医疗保险统筹基金收支平衡是深化医疗保险制度改革的基础,也是一项十分复杂的系统工程。本文在综合了主要研究文献基础上,探讨了影响医疗保险统筹基金收支平衡的因素(政策因素,医疗保险经办机构因素,定点医疗机构、参保人和参保单位因素,人口增长因素,结算方式因素,疾病谱因素等),提出了保持基金收支平衡的若干对策。

The balance between income and expenditure of pooling funds of basic medical insurance is not only a basis of deepening reform of medical insurance system,but also a very complex system project.Based on having reviewed many literatures,and the author analyzes some factors that influence the balance between income and expenditure of pooling funds of basic medical insurance(policy,medical insurance agencies,designate medical institutions,participants and participants units,population growth,the way of settlement, spectrum and so on).And puts forward several countermeasures to keep the balance between income and expenditure of pooling funds of basic medical insurance.