云南省完善医疗保险异地就医服务管理的现实选择

A realistic option for cross-region medical service provision of the social healthcare system in Yunnan Province

现行的城镇职工医疗保险制度存在统筹层次低、统筹地区多、地区之间的医保政策和待遇标准以及管理办法各不相同的情况,随着人口流动性的不断增大,异地就医数量日益增加,异地就医和医疗费用结算等方面矛盾重重,一定程度上影响了制度的公平性。本文以云南省为例,在抽样调查的基础上分析了异地就医服务管理的现状,针对突出问题,提出了改进的对策和建议。

The current basic social healthcare system for urban and township employees still differs in terms of specific insurance plans, medical expenses reimbursement policies and other benefits and rules at different regions. As the population mobility increases, cross-region medical service demands are increasing constantly. And the system is facing with many problems arising from cross-region medical service provision and medical expenses settlement. Improper solution of these problems will affect the fairness of the system. The paper used Yunnan as an example to analyze the current situation of cross-region medical service provision management based on the results of a sample survey, and put forth suggestions on how to solve the main problems.