提高城乡居民医保经办管理效能的措施及成效

Measures to Improve the Efficiency of Urban and Rural Residents Medical Insurance Management

山东省城乡居民基本医疗保险制度全面整合运行已有两年之余,通过梳理总结具体工作措施,结合实际运行数据及案例的对比分析,从经办服务效能角度初步评价整合工作。山东省通过实施全面整合,规范加强经办管理,提高了参保人员就医及办理其他业务的便捷性,使城乡居民医疗保险制度更加公平更可持续,巩固完善了该项制度。并根据运行情况,提出支付方式改革、强化协议管理、信息化建设及提高经办效率等建议。

The basic medical insurance system for urban and rural residents in Shandong province has been fully integrated operation for more than two years. Through combing the specific work measures, comparing with the actual operation data and cases, this paper evaluates integration work from the view of service management effectiveness. Through the implementation of a comprehensive integration, standardize the management of strengthening, Shandong province improved the convenience of the insured for medical treatment and for other businesses. So the medical insurance system become more equitable, healthy and sustainable, the residents＇ medical insurance system get consolidation and improvement. According to the operation situation, this paper puts forward the reform of the payment method, the strengthening of the agreement management, the information construction and the improvement of the management efficiency and so on.