城乡统筹医疗保险制度效果评价——基于天津、重庆、宁夏的实证研究

Evaluation of effectiveness of urban and rural integrated medical insurance system:An empirical study based on Tianjin,Chongqing and Ningxia

目的:对天津市、重庆市和宁夏自治区城乡居民医疗保险制度效果进行综合评价,为政府相关部门制度设计提供政策建议。方法:构建城乡统筹医疗保险制度评价指标体系,运用"纵横向拉开档次"法对制度效果进行评价。结果:(1)试点城市城乡统筹医疗保险制度公平性和制度政策保障水平较高,但医疗服务保障水平和医保制度可持续性仍是制度运行的短板;(2)由于人口数量、经济发展水平等差异,三个地区制度效果存在明显差异。结论:试点城市应在吸收其他省市经验基础上,从坚持政府领导、加强顶层设计、加大财政投入力度、完善筹资和费用报销机制、加强医保基金监管等几方面进一步对制度进行完善。

Objective: To comprehensively evaluate the urban and rural residents' basic integrated medical insurance system,taking Tianjin,Chongqing and Ningxia as case study areas,to provide policy suggestions to relevant government departments. Methods: The evaluation index system for urban and rural residents' basic integrated medical insurance system was constructed and made use of the scatter degree method for the evaluation of the effect of the system. Results:( 1) Fairness and policy guarantee are higher relatively,while the medical service and sustainability are still running short for the urban and rural residents' basic integrated medical insurance;( 2) Effect of the urban and rural residents' basic integrated medical insurance system of three municipalities is obviously different due to the difference in their respective population size,economic development,etc. Conclusions: Reasonable policy suggestions put forward to the pilot cities to improve the urban and rural residents' basic integrated medical insurance system,such as strengthening the top-level design of policy,increasing fiscal subsidies and improving the mechanism of fund-raising and reimbursement and strengthening the supervision of the medical insurance fund.