城镇医保管理实践对新型农村合作医疗的借鉴作用研究

Study on the Revelation to New Cooperative Medical Scheme of Urban Medical Insurance Management Experiences

自1994年城镇职工基本医疗保险制度实施以来,在具体的管理实践中制定了相对完善的政策法规,建立了相对健全的管理队伍,积累了加强信息化建设等方面的经验,同时,也出现了基金安全和费用控制力度需要加强等问题。借鉴城镇职工基本医疗保险管理实践经验,新型农村合作医疗应当继续坚持卫生部门主管的管理体制,并加强管理和经办机构的能力建设,做好费用控制和行为规范等方面的工作,保障新型农村合作医疗的稳健运行。

Since the implementation of urban medical insurance scheme in 1994, some experiences of urban medical insurance management have provided revelation to new cooperative medical scheme （NCMS）. These experiences include perfecting relevant policies and regulations, strengthening the building of management agencies and the recruitment of staff, and managing the system with information technology so as to improve the management level and efficiency. At the same time, there exist some disadvantages in the management and operation of urban medical insurance scheme, such as laying undue stress on the safety of fund, failing to control the medical expenses effectively. Consulting the experiences and lessons in urban medical insurance management, some measures should be taken so as to ensure the stable operation of NCMS. Firstly, insist on the management system of NCMS （i.e. managed by the health department of governments） . Secondly, strengthen the building of management agencies and management ability. Thirdly, control medical expenses and regulate medical services effectively.