嘉兴市城乡统筹医疗保险体系的主要做法

Main measures of balancing urban and rural medical insurance system in Jiaxing City

浙江省嘉兴市从统筹城乡发展的实际出发,建立城乡居民合作医疗制度。2009年,共有223.4万城乡居民参保,其中,农民参保率为97.53%,城镇居民参保率为87.18%。全市住院报销比率为40.87%,门诊报销比率为23.55%。嘉兴为城乡居民提供统一的医疗保障,同时建立筹资动态增长机制,稳步提升保障水平,并明确有卫生部门主管,确保合作医疗安全高效运行。管理措施上,在全市范围内实施统一的合作医疗政策,为实现合作医疗市级统筹奠定了基础。本文建议,加快推进合作医疗法制化进程,提高统筹层次;增强合作医疗的保障能力,创新管理体制与管理方法,探索合作医疗可持续发展的路径。

In view of coordinated development of urban and rural area,the Urban-Rural Cooperative Medical Scheme（URCMS）has been established to provide the unified medical insurance for urban and rural residents in Jiaxing City,Zhejiang Province.In 2009,2.23 million residents have enrolled in the URCMS,with 97.53% and 87.18% enrollment rate for rural and urban residents respectively.As for reimbursement rate,40.87% inpatient and 23.55% outpatient expenditure could be compensated.Meanwhile the steady growth mechanism of fund-raising has been launched to promote the protection level.In addition to ensure the safety and efficiency of URCMS,the local health administration has been authorized to be in charge of the fund operation.And unified policy and management approach have been utilized across the whole area in Jiaxing City,making a strong foundation to lift the fund pool level to the whole city.In the end,the paper recommends that legal process be accelerated to push forward the sustainable development of New Rural Cooperative Medical Scheme and more efforts should be made to raise the fund pool level,reimbursement rate and management.