健康扶贫背景下的医疗保障风险分析及应对策略研究

Analyzing the Medical Security Risk under the Background of Health Poverty Alleviation and Its Countermeas-ures

近年来,健康扶贫作为国家脱贫攻坚战重点工程成效显著。本文通过政策及文献的梳理与分析并开展青海、甘肃地区的实地调研,发现健康扶贫工作中存在政策宣传与执行的偏差;在缺乏合理的资金支持下存在不适当地提高医疗待遇,导致贫困人群"钻"政策空子,增加医保基金的超支风险。因此,本文提出加强国家政策的准确解读,以矫正管理者和扶贫对象的理解与认识;突出保基本、护健康、减负担的健康扶贫宗旨,合理确定医保政策;增加健康扶贫专项经费;加大多方监管防控力度,防范供需双方的道德风险,保障健康扶贫下医疗保障工作的平稳运行。

In recent years, as a key project of national poverty alleviation, health poverty alleviation has achieved remarkable results. Based on analysis of policies and academic literature and field research in Qinghai and Gansu, some problems in health poverty alleviation were found, such as deviation between policy propaganda and implementation, inappropriate improvement of medical treatment without reasonable financial support, which increased the risk of over expenditure of medical insurance fund. It is suggested to strengthen the accurate interpretation of national policies, highlight the purpose of health poverty alleviation of basic protection, health protection and burden reduction, reasonably determine the medical insurance policies, increase the special funds for health poverty alleviation, intensify the supervision and control of multiple parties, so as to prevent the moral hazards of both supply and demand sides, and ensure the smooth operation of medical security for health poverty alleviation.