我国三项基本医疗保障制度保障状况分析

Status quo of China's three basic medical security systems

目的:分析职工医保、居民医保和新农合三项制度的保障范围、保障程度和保障效果,为完善基本医疗保障制度提供建议。方法:根据国家相关部门发布的资料数据计算相关指标,对保障状况进行描述。结果:保障范围方面,新农合参合率较高、覆盖服务范围较广,职工医保和居民医保需要进一步提高实际参保率、扩展统筹基金保障范围;保障程度方面,职工医保和新农合的住院补偿受益面高于居民医保,职工医保的实际住院补偿水平高于居民医保和新农合;保障效果方面,新农合在降低参合人员经济负担、提高医疗服务利用率方面发挥了较积极的作用,职工医保的保障效果需要进一步加强。结论:建议针对性地采取措施,完善各项基本医疗保障制度。

Objective To analyze the scopes, levels and effects of UEBMI （urban employees＇ basic medical insurance） ,URBMI （urban residents＇ basic medical insurance） and NRCMS （ new rural cooperative medical scheme） and to propose some suggestions on the improvement of basic medical security systems. Methods We calculated some indicators according to materials and data released by relevant government departments and described the current status. Results In terms of security scopes,NRCMS had a relatively high enrollment rate and relatively wide service package. UEBMI and URBMI needed to further increase their actual enrollment rates and widen the security scopes of pooling funds. In terms of security levels,the benefit rates of inpatient reimbursement in UEBMI and NRCMS were higher than that in URBMI and the actual reimbursement ratio of inpatient services in UEBMI was higher than those in URBMI and NRCMS. In terms of security effects,NRCMS had played a positive role in relieving enrollees＇ financial burdens and increasing medical services utilization while the security effect of UEBMI needed to further improve. Conclusions It is suggested to take targeted measures to improve the three basic medical security systems.