我国职工医保门诊保障的现状及改革思考

The Situation and Consideration of Outpatient Co-ordination Reform for Urban Employee Medical Insurance

推动职工医保门诊保障由个人积累式保障模式转向社会互助共济保障模式,是深化医疗保障制度改革的重要内容之一。本文梳理了我国职工医保门诊保障的现状和特点,在全国层面估算了门诊共济保障改革后可用基金规模、门诊保障需求和可支付水平。结论认为:我国职工医保门诊保障的推进形式和保障水平存在差异,应因地施策、循序渐进,结合人口、地区、原有政策设计等因素做好门诊改革的预测和评估。

It is one of the important contents to deepen the reform of healthcare security system to promote the employees’medical insurance outpatient protection from the individual accumulation-type guarantee model to the social mutual assistance guarantee model.This paper combs through the current situation and main characteristics of medical insurance outpatient protection for urban employees in China,and estimates the size of funds available after the reform of outpatient co-ordination at the national level,as well as the demand and payable level of outpatient protection.Conclusion:There are diff erences in the promotion form and level of medical insurance outpatient protection for urban employees in China,and the government should make a good prediction and evaluation of outpatient reform according to local policies,step by step,combined with population,region and original policy design and other factors.