城镇职工基本医疗保险个人账户改革现状及机制分析

Current Situation and Mechanism Analysis of Personal Saving Accounts Reform of Basic Medical Insurance for Urban Employees

目的:描述城镇职工基本医疗保险个人账户改革现状并进行机制分析。方法:通过文献评阅和政策分析对23个样本地区的城镇职工基本医疗保险个人账户原有功能和改革现状进行梳理总结,并结合实地和电话访谈获取个人账户改革情况及存在问题。结果:针对于个人账户功能有限导致基金沉淀浪费等问题,17个地区进行了改革,主要采取筹资改革、支付拓展以及现金提取三种模式,以支付拓展为主。结论:通过对不同改革模式及其具体措施进行了利弊机制分析后,认为个人账户改革可优先采用支付拓展改革模式,并以基本医保范畴内的支付拓展为主,在加强对个人账户使用监管的同时,全面推行普通门诊统筹以实现门诊费用的互助共济。

Objective: To describe the existing reforms and conduct a mechanism analysis of the personal saving accounts (PSAs) of the basic medical insurance system for urban employees. Methods: Through literature review and policy analysis, it investigated the former functions and the existing reforms of the urban employees basic medical insurance PSAs in 23 sample sites, and combined field and telephone interviews to obtain the existing reforms and problems of PSAs. Results: It found 17 of the study sites had reformed and mainly adopted 3 models of reform which could be categorized as financing reform, payment expanding and realizing cash to tackle the functional limitations of PSAs. Conclusion: Giving priority to the payment expansion model when reforming the PSAs, within the scope of basic medical insurance scheme in particular, and the outpatient pooling fund for common diseases should be established and refined to pool the financial risks among population.