城乡居民基本医保制度整合路径设计——以山西省太原市为例

The Route Design of the Integration of Basic Medical Insurance System for Urban and Rural Residents——A case study of Taiyuan,Shanxi Province

整合城乡居民基本医疗保险是山西省增进医保制度公平的重要步骤。文章以山西省太原市为例,从参保缴费、住院待遇、门诊待遇、管理服务等方面对比分析城镇居民基本医保与新农合制度,发现两项制度分立已造成重保错保、筹资待遇不公及管理低效等问题。针对该问题提出了强制参保、自选缴费档次、缩小筹资待遇差距、循序渐进的整合思路,进而设计了太原市城乡居民基本医保制度整合路径及路径实现手段。

The integration of basic medical insurance for urban and rural residents is an important step to improve the equity of health insurance system in Shanxi Province. This paper,in which Taiyuan was taken as an example,and a comparison between the basic medical insurance for urban residents and the new rural cooperative medical care system from the insured payment,hospitalization reimbursement,outpatient reimbursement and management services was made,found that the separation of the two systems had resulted in serious problems such as repetitive and mistaken insurance,unfair financing and inefficient management. It then put forward the ideas for integration such as compulsory insurance,optional pay grade,narrowing financing treatment gap,and step-by-step implementation. Besides,it offered to design the path and the realizing means for the integration of basic health insurance system of urban and rural residents in Taiyuan.