浙江省完善职工医保个人账户政策的阶段性效果与问题分析

Analysis On The Phased Effect And Problems Of Perfecting The Policy Of MSAs Of UEBMI In Zhejiang

城镇职工基本医疗保险制度建立以来,个人账户以“保小病”的定位为保障参保人门诊医疗费用作出了重要贡献。然而,随着制度多年运行,个人账户总体结余规模庞大、支付能力不平衡、弱化统筹资金筹资能力、出现不合理使用现象等问题逐渐显露,促使许多省市开始探索完善个人账户政策。随着2020年《中共中央国务院关于深化医疗保障制度改革的意见》的出台,进一步改革个人账户政策成为全国医保部门面临的重要课题。浙江省作为我国医保政策探索前沿,自2012年就开始以活化历年结余资金为核心对个人账户政策进行完善。本研究基于浙江省内六个医保统筹地区的实践,系统分析了浙江省完善个人账户政策取得的阶段性效果与面临的问题,旨在为浙江省与全国其他地区下阶段深化个人账户改革提供参考。

Since the establishment of urban employees’basic medical insurance(UEBMI),medical saving accounts(MSAs)has made an important contribution to paying for outpatient expenditures with the role of"protecting insured form minor diseases".However,with UEBMI running for a long period,problems of MSAs such as surplus overall accumulation,unbalanced payment ability,cutting down the scale of risk-pooling fund,and unreasonable use have gradually emerged,prompting several provinces and municipalities to reform local MSAs policies.With the release of The Opinions On Deepening The Reform Of Healthcare Security System in 2020,further reform of the MSAs policy has become an important issue facing the nationwide healthcare security departments.As the forefront of China's healthcare security policy reform,Zhejiang has been adopting its MSAs policy since 2012,taking the activation of surplus MSAs accumulation as the core of reform.Based on the practice of six sites,this study systematically analyzed the eff ects and problems of the reform of MSAs policies,aiming to provide reference for deepening the reform of MSAs in Zhejiang and other regions in China in the next stage.