公平与效率兼顾的城乡居民医保整合——以济宁市为例

The Integration of Urban and Rural Residents Health Insurance Considering both Fairness and Effectiveness——based on the practice in Jining

新型农村合作医疗与城镇居民基本医保制度的整合,不是因为谁优谁劣,而是建立更加公平更可持续全民医保制度的必然要求。济宁市2014年6月整合城乡医保管理体制、2015年1月实施全市一体化城乡居民医保制度后,在应保尽保、筹资和待遇水平、目录管理和定点管理、信息系统建设等方面,实现了城乡统一。通过整合医疗保险监管力量,监管效率明显提升。将两项制度整合为一项制度,使定点医院精简了医保经办机构,管理成本降低,办事效率提升。

The integration of New Rural Cooperative Medical Care System and the basic health insurance system for urban residents is not because who is better or worse, but for the inevitable requirements raised to create a fairer and more sustainable health care system for the people. In June 2014 in Jining, the management system for urban and rural medical insurance has been integrated. After the integration of urban and rural resident＇s health insurance system in January 2015, the goals of all-insured, and unifying in the level of financing and treatment, in the management of directory, designated institution, and information system construction have been achieved. By integrating medical insurance regulatory forces, the supervising efficiency has been improved significantly. The integration has made designated hospitals simplifying the insurance agencies, reducing the management cost and increasing the operation efficiency.