城镇职工基本医疗保险统筹基金运行情况及统筹基金住院支出影响因素的调查分析

Operational Statue of Pooling Funds Basic Medical Insurance for Urban Working People and Its Influencing Factors for Hospitalization Costs

目的了解城镇职工基本医疗保险统筹基金的运行情况,探讨统筹基金住院支出的影响因素,提出符合我国医疗保险现状的对策。方法以某市为例,对该市统筹基金的运行现状进行描述,并从统筹基金住院支出的角度对医疗保险统筹基金的使用现状进行分析。结果影响统筹基金住院支出的因素为药品费、个人现金支付、当年月交费、个人账户支付、起付标准、公务员补助、年龄。结论统筹基金住院支出的影响因素包括系统内风险因素和系统外风险因素两种。建议财政介入建立"老龄化医疗风险基金",以抵御人口老龄化给基本医疗保险基金运行带来的各种风险;控制医疗费用的快速上涨;重视社区卫生服务的建设,建立多层次的医疗保障体系。

Objective To investigate the operational status of pooling funds of basic medical insurance for urban working people,and its influencing factors for hospitalization coast so as to put forward strategy in accordance with the present status of medical insurance in China.Methods Take one city for example,to describe the operational aspect of the pooling funds in the city and analyze the use of pooling funds from the respect of hospitalization costs.Results The factors influencing hospitalization expense of pooling funds were drug fees,personal cash payment,payment per month in the same year,proprietor＇s personal bills,starting standard of payment,allowance to officeholder,and age.Conclusion The factors influencing hospitalization expense of pooling funds include both internal and external risk factors.It is suggested to set up ＂a medical risk founds for the aging of population＂ by government expenditure so as to resist carious risks resulting from aged tendency of population;to control rapid increase of medical fees;pay more attention to establishment of community health services,and create a multilevel medical security system.