城乡居民医疗保险制度整合中的资金管控风险

Risks of Fund Management and Control in the Integration of Urban and Rural Medical Insurance System

城乡居民医疗保险制度整合是以资金制度的整合为基础,但随着财政资金在医保方面投入的增加,居民并未感到就诊费用的大幅降低。通过对医保资金管控及其相关制度的研究发现,筹资增幅过快、统筹标准模糊与诊疗基础薄弱是医保资金管控面临的主要风险。另外,从长远来看,资金管控风险可能会反向作用于基层诊疗基础,如果不能从根本上解决当下的资金管控风险,制度整合能激发的制度活力也会受到限制,并最终影响城乡基本公共服务的均等化问题。

The integration of the urban and the rural medical insurance system is based on the integration of the funding system.However,with the increase in financial investment in medical insurance,residents did not feel a significant reduction in the cost of medical treatment.Based on the research of medical insurance fund management and control and related systems,this thesis found that excessively rapid funding increase,fuzzy overall planning standards and weak diagnosis and treatment foundation are the main risks faced by medical insurance fund management and control.In addition,in the long run,the risk of capital management and control may have a negative effect on the foundation of basic diagnosis and treatment at the grass-root level.If the current capital management and control risks cannot be fundamentally resolved,the vitality of the system that can be stimulated by system integration will also be limited,and ultimately affect the equalization of basic public services in urban and rural areas.