居民医疗保险基金收支缺口形成原因及对策建议——以山东省临朐县为例

The Reason Why Social Medical Care Fund Deficit Coming into Being and How to Fix it——Taking Linqu County as an Example

居民医疗保障制度作为服务于广大居民最基本的一项社会保障,对解决人民群众看病难、看病贵具有重要作用。随着居民医疗保险覆盖面不断扩大、医保统筹支付诊疗项目增加、报销比例提高和医疗费用大幅增长,县域内居民医保定点医疗机构不同程度地出现了医疗保险基金超定额、超指标使用现象,基金当期超支规模不断扩大,地方财政面临弥补大额超支压力,确保居民医疗保险制度健康可持续运行显得尤为重要。本文以临朐县为例,对居民医疗保障制度运行过程中存在的问题及原因进行了分析,并提出了解决建议,以寻求居民医疗保险基金可持续发展之路。

Social medical care an important role in addressing system is a basic social security network serving the normal citizens, and plays people＇s medical demands. With the covering scope expanding of the system, the increase in expenditure items and percentage covered by the system, the citizen medical care providing units faces such difficulties as medical insurance fund exceeding its cap, exceeding its percentage, current deficit amount keeping increase rapidly and quickly, the local government finance has to face the pressure to compen- sate large fund deficit. All these are quite important to ensure the sustainable healthy operation of social medical insurance system. This article takes Linqu county as an example, discusses the problems underlying the system, and tries to provide recommendations to help its sustainable development and operation.