医保基金当期收不抵支的原因分析及治理对策建议——以新疆油田职工医疗保险为例

Reasons Analysis and Countermeasure Suggestions of Medical Insurance Fund’s Expenditure Outweighs Income in the Current Period——Taking Xinjiang Oilfield Workers’Medical Insurance as an Example

2018年,新疆油田参保人数稳中有增,国家医保局组织的17种抗癌药降价谈判等利好举措极大减轻了油田参保职工的医疗负担,成为职工获得感更多的一年。但由于在职退休比缩小、缴费基数和缴费比例下调、个人账户过度购药、门诊费用增幅过大等因素,导致医保基金当期收不抵支。因此要加强医保信息化建设,为智能监控、大数据应用提供支撑;全面加强医保专项检查,严厉打击欺诈骗保行为,强化威慑力;深入推进医保付费机制改革,实施战略性购买。

In 2018,the number of insured persons in Xinjiang oilfi eld increased steadily. The favorable measures such as the negotiation of 17 kinds of anticancer drugs price reduction organized by the National Healthcare Security Administration greatly reduced the medical burden of insured workers in oilfi elds. However,due to the reduction of the "proportion of staff to retirees",the reduction of the base and proportion of contributions,the over-purchase of drugs in personal accounts and the excessive increase of outpatient expenses,the current income of the medical insurance fund is not off set. It is urgent to strengthen the construction of medical insurance informationization to provide support for intelligent monitoring and big data application,comprehensively strengthen the supervision of purchasing drugs with social security cards in personal accounts and special inspection of medical insurance,severely crack down on fraudulent insurance and strengthen deterrence,and further promote the reform of medical insurance payment mechanism and implement strategic purchasing.