制度公平与服务均等相得益彰的探索——基于苏州医保的实践

The Exploration of Mutual Benefit between System Equity and Service Equality——Based on the Practice of Suzhou Medical Insurance

苏州医保经过多年不懈探索,制度公平性和公共服务均等化取得相得益彰之效。参保对象的全覆盖,同类人员同等缴费标准,经办服务的一体化,使城乡各类群体享受公平的参保机会和参保服务;多层次保障体系的确立,使全体参保人员尽享多层次医保待遇,特别是率先实施的"四位一体"的医疗救助体系和一体化管理,堪称全国范例;网格化的经办服务体系,电子化的经办服务平台,数字化的社保权益获取渠道的建立,提升了经办服务的便捷性;多手段的两定管理,全过程的医保监管,有规可依的就医管理,为医保管理功能的可持续提供了保障。

After many years of unremitting exploration of the medical insurance in Suzhou, institutional justice and equalization of public services achieve the best results. It covers all insured residents, the same kind of personnel pay standards,the management services integration, so that all types of urban and rural areas enjoy a fair opportunity to participate in medical insurance and acquire insurance services.Suzhou medical insurance established a multi-level security system, so that all insured residents enjoy multi-level medical care treatment, especially the first implementation of the four in one medical assistance system and integrated management,called the national example.It established a grid of the service system, the electronic service platform, and the digital access to social security interests, enhancing the convenience of handling services.Suzhou medical insurance has established two means of management, the whole process of medical insurance regulation, and the medical management,providing protection for the sustainable management of medical insurance.