新疆兵团某师城镇职工基本医疗保险基金结余水平及控制分析

Analyzing the balance and control of fund of basic health insurance for urban employees in Xinjiang Production and Construction Corps

目的:分析城镇职工基本医疗保险基金结余水平,结合医保患者住院费用分布及特点,探讨基金结余不足成因及控制方法。方法:采用描述统计分析方法分析职工医保基金结余及住院患者情况。结果:城镇职工基本医疗保险基金结余不足;政策内报销比例与实际报销比例相差不大;离退休及老龄医保患者是基金的主要使用群体,是引起医保基金结余不足的主要成因。结论:完善医疗保险待遇制度、建立双向转诊制度是改善城镇职工基本医疗保险基金不足的重要举措。

Objective To analyze the balance of fund of basic health insurance for urban employees, and study its causes and Methods The status of balance of fund of basic health insurance for urban employees and distribution of inpatients were studied with descriptive statistical method. Results There had inadequate fund of basic health insurance for urban employees. The gap between the reimbursement proportion within the range of policy and the actual reimbursement proportion of hospitalization expenses was close. The main groups using this fund were retired and elderly people, which was the main cause to inadequate fund. Conclusion It is an important measure to improve medical insurance system and develop two-way referral system for balancing the fund of basic health insurance for urban employees.