整合城乡居民医疗保险制度研究:以浙江省嘉兴市为例

Research on the Integrating the Urban-rural Resident Medical Insurance System: Taking Jiaxing of Zhejiang as an Example

目的:以嘉兴市为例,分析城乡居民医疗保险制度整合现状、做法、成效及问题,为推进城乡居民医疗保险制度整合提出相关建议。方法:对嘉兴市城乡居民基本医保情况开展现场调研,访谈相关人员了解整合现状。结果:嘉兴市2014年建立城乡居民基本医疗保险,并全部与职工基本医疗保险实施整合。通过"四个统一"夯实全民医保、提高三大水平、增强制度公平性、惠益百姓。但存在新的问题值得进一步思考和参考。结论:嘉兴市基本医保制度整合取得了显著成效,尤其在经办人员培训方面表现突出。但仍需发挥信息化作用、加强基层队伍建设和完善商保经办制度建设以建立健全全民一致的医疗保险体系。国家更应加强顶层设计,实现制度自上而下有效整合。

Objective：To analyze the current situation, practices, effects and problems of integrating urban and rural resident medical insurance system and provide suggestions for the integration.Methods：Field survey was performed on the situation of the basicmedical insurance system in Jiaxing and interviews were implemented for studying the integrated situation.Results：In 2014, the basic medical insurance system for urban and rural residents has been established in Jiaxing and has been implemented integration withthe medical insurance for urban employees. ＂Four unification＂ were applied to reinforce universal medical insurance, raise three levels, enhance the equity of the system and benefit people. But there were new problems which deserved further consideration and references.Conclusion：Although the integration of basic medical insurance system has made remarkable achievements in Jiaxing, especially in the training of personnel, the government sill needed to boost the function of informatization, accelerate talents squad construction and improve the commercial insurance administrating system so as to establish the universal medical insurance system. Thegovernment should strengthen top-level design for realizing the the effective top-down integration of the system.