山东省部分城市基本医疗保险基金结余研究

Study on the Operational Status of Social Basic Medical Insurance Fund Surplus in Several Cities in ShanDong Province

通过对部分市开展医疗保险制度改革和基金结余情况研究,分析了城镇职工基本医疗保险、城镇居民基本医疗保险基金结余率高、合作医疗部分基金结余率出现赤字的原因以及城镇居民基本医疗保险试点反映的问题等,就加强医疗保险服务提出:(1)充分发挥基层卫生机构的医疗健康保障作用;(2)完善医疗保险待遇制度;(3)探索优化医疗费用结算方式;(4)改善医疗保险基金的监督管理;(5)减缓政府补助提高速度。

Through studying on the reform of social medical insurance system and on the status of social medical insurance fund surplus in several cities, the paper analyses reasons for high ratio of fund surplus to basic medical insurance for urban employees, urban citizens, and deficit of fund to new rural cooperative medicine, and some problems exposed during doing experiments of the urban citizens＇ basic medical insurance. In order to enhance the medical insurance service, the paper suggests： （1） Fully elaborating function of the medical and healthy service of the basic healthy organ. （2） Improving the medical insurance treatment system. （3） Exploring settlemtnt method which can optimize the medical payment. （4） Perfecting the supervision and management of medical insurance fund. （5） Slowing down government increasing speed of subsidy to the urban citizens basic medical insurance.