摘要
通过对北京市城镇职工基本医疗保险基金的运行分析和测算,发现:(1)医疗基金的波动主要是大额互助部分造成的,并且住院补偿金额占了70%以上的比例;(2)现行的报销补偿规定有利于较高级别的医院,导致三级医院“拥挤”与基层医疗服务利用不足并存;(3)多种医疗补偿制度的并存加大了管理成本和基金风险监控的难度,也是造成现阶段医疗基金管理效率损失的主要原因。对此,笔者提出了解决措施。
By analyzing and calculating urban employees'basic medical insurance fund,several findings were of significance.One was that the fluctuation of medical fund is mainly due to the part for much money reimbursement,and hospitalization reimbursement took up70%of medical fund.The other was that the present reimbursement regulations were beneficial for high-level hospitals,which led to busy tertiary hospitals and lowly utilized primary medical services.Another was that the coexistence of multiple medical reimbursement systems increased management cost and difficulties in supervision of fund risk,and also formed the main reason for lost efficiency for medical fund management.Countermeasures to these findings were presented in this paper.
基金
北京市劳动与社会保障局协助
邓小平理论研究基金资助
关键词
医疗保险基金
风险
服务利用
medical insurance fund
risk
service utilization
