我国健康管理型医保基金运营风险控制建议

Suggestions on Risk Control of Operation of Health Management Medical Insurance Funds in China

我国健康管理型医疗保险基金可采用以家庭为缴费单位、打破户籍限制、差异化筹资补偿、广覆盖的模式;成立专门的医保基金监管机构,拓宽医保基金投资渠道,建立医保共付制度。运营过程中计提收益波动准备金和风险准备金,控制医保基金投资风险;提高统筹层次,并择机推出特种税收,以弥补缺口;同时构建全国统一的健康管理档案和医保大数据,有效控制运营风险。

Health management medical insurance fund can adopt the model of taking family as payment unit,breaking household registration limit,differential financing compensation and wide coverage.The establishment of special medical insurance fund regulatory agency can widen investment channels,establishing the medical insurance co-payment mechanism.In the course of operation,the profit fluctuation reserve and risk reserve shall be set aside to control the investment risk of the medical insurance fund.To raise the level of pooling and introduce special tax to make up the gap.At the same time,the national unified health management records and medical insurance big data should be built to effectively control operational risks.