提高医保基金管理效益的财务研究

Financial Research on Enhancing Management Efficiency of Health Insurance Fund

社会医疗保险是一项巨大的民生工程,经过多年的运行,已经初步达到了预期目的,但尚有许多亟待完善的地方;同时在发展过程中又会面临许多新的问题和挑战,需要用新的举措予以应对,这些问题比较集中地体现在医保基金所涉各方的利益平衡、均衡医疗资源、医保基金城乡统筹、医保基金收支平衡和安全运行、弱势群体就医权益的保护等五个方面。为此,以财务视角的研究方法进行深度分析,从而找出相应的解决措施,推进医保基金管理更加科学化、效益最优化。

Social health insurance is a huge livelihood projects, with years＇ operation, it has primarily reached the desired target, but it still has a lot of shortcomings needs to be completed. While under the development process, it will face a lot of new problems and challenges that need to be dealt with new initiatives; these problems largely focus on five aspects： the benefit balance of stakeholders involved in health insurance fund, the balance of medical resources, co-ordination of health insurance fund of cities and counties, the payment balance and safe operation of health insurance fund, and the medical benefit protection of vulnerable groups. For above reasons, this paper conducts deep analysis from the perspective of financing and tries to find related solutions, and then prompt the scientific management and the benefit optimization of social health insurance fund.