医保基金分析预警指标体系构建研究——基于泰安市的实践探索

A Study on the Construction of Medical Insurance Fund Analysis and Early Warning Index System

泰安市着力构建医保扩面、基金征缴、基金使用效率效益、医疗管理评价等四种32个指标在内的医保基金分析预警指标体系,为科学决策、合理有效控费、提升基金使用效率效益提供有力支撑。通过2016年9-12月份的运行,全市医保超总额指标比例较1-8月份回落9.8个百分点,医疗费用不合理过快增长的势头得到初步遏制,为泰安市医疗保险事业健康发展奠定了良好基础。

In Taian, medical insurance fund analysis and early warning index system, which includes 32 indicators of four categories such as medical insurance covering, fund raising, fund efficiency, and medical management evaluation, was established to offer strong support for scientific decision, reasonable and effective cost control, and fund efficiency. During September to December, 2016, the ratio of over-cost in total medical insurance fund was reduced by 9.8% compared with those during January to August, which indicates that the unreasonable over-growing medical expenses have been controlled and laid a good foundation for the development of medical insurance business in Taian.