基于试点推进的郑州市城镇基本医疗保险实施现状分析

Analysis on the Current Situation of Implementation of Basic Medical Insurance in Zhengzhou City Based on Pilot Propulsion

目的为城镇医疗保障制度改革提供参考。方法运用调查研究和内容分析方法,系统地对郑州市城镇基本医疗保险相关文件、统计公报、数据等进行查询和分析。结果郑州市城镇基本医疗保险制度已形成了完善的文件体系,对郑州市城镇职工、城镇居民各类群体实行了全覆盖,2016年底参保率为70. 55%;医保待遇不断提高,个人经费负担比例不断下降; 254家定点医疗机构和730家定点药店进行了基本医疗保险专业服务。结论郑州市城镇基本医疗保险制度呈现良好的运行态势,但医保待遇、筹资标准与南京市等先进城市相比还有一定差距,参保率需进一步提高,同时要发展医疗保险的第三方支付机构,不断促进个人账户制度的改革,完善城镇基本医疗保险管理平台建设。

Objective To provide a reference for the reform of urban medical insurance system. Methods The relevant documents,statistical bulletins and data of basic medical insurance in Zhengzhou City were systematically inquired and analyzed by means of investigation and content analysis. Results The basic medical insurance system in Zhengzhou City has formed a perfect document system,it covered all kinds of urban workers and urban residents in Zhengzhou City,with a rate of 70. 55% at the end of 2016. Medical insurance has been continuously improved,and the proportion of personal financial burden has been declining. Totally 254 designated medical institutions and 730 designated drugstores have carried out professional services of basic medical insurance. Conclusion The urban basic medical insurance system in Zhengzhou City presents good running state,but there is still a certain gap in medical insurance treatment and financing standards compared with advanced cities such as Nanjing City,and the insured rate needs to further improve. At the same time,the third-party payment institutions of medical insurance should be developed to promote the reform of personal account system,and improve the management platform of urban basic medical insurance.