新农合基金管理在城乡居民基本医疗保险整合中的风险研究

Research on Risk Management of New Rural Cooperative Medical System Based on the Establishment of Urban and Rural Residents' Medical Insurance System

目的分析新农合基金在城乡居民基本医疗保险制度整合中可能遇到的风险,提出合理、有效的风险防控与管理建议。方法采用专家咨询和头脑风暴法找出主要的风险点,再使用鱼骨法对风险及其原因进行分析。结果城乡居民基本医疗保障制度建立过程中,在政策制定、运营管理和保障支撑三个环节的不同方面均存在一些风险点。结论应按照"先归口、后整合"的路径理顺行政管理体制,按照"一制多档,筹资与补偿相衔接"的形式设计筹资补偿方案。同时,重视信息系统的整合,以及对农村地区的医疗资源投入和财政补贴,避免制度过渡期间参保农民补偿水平下降而影响农民的参保积极性。

OBJECTIVE To analysis the risk of the establishment of urban and rural residents basic medical insurance system and propose reasonable, effective risk prevention and management advice. METHODS Use expert consultation and brain storming to identify major risk areas, then use the fish bone to analysis the risk and their reasons. RESULTS There were some risk points from three different aspects, such as policy development, operation management and security support in the process of establishing of urban and rural residents medical insurance system. CONCLUSION Proposed some suggestion to prevent the risk in the integrate processing. Administrative system according to the principle of ＂first centralized, then integration＂ . According to the principle of ＂multi-system, financing and compensation convergence＂ to design the financing and compensation scheme. Pay attention to the integration of information system, increase the investment and financial subsidies in rural areas and avoid the decline in compensation for farmers affected the participation enthusiasm of the insured farmers.