摘要
我国职工医保个人账户是特定时期的改革产物,随着医保制度改革深化,职工医保门诊保障由个人积累模式转向社会互助共济模式。运用SWOT分析法,对个人账户和门诊统筹的优势、劣势、机会和威胁进行对比分析,并借鉴国际经验,预判改革带来的影响,从待遇政策衔接、支付方式改革、服务监管监控、门诊服务供给等关键环节提出对策建议。
The individual account of the employee medical insurance in China is the product of the reform in a specific period.With the deepening of the reform of the medical insurance system,the employee medical insurance outpatient guarantee has changed from the individual accumulation mode to the social mutual assistance mode.The SWOT analysis method was used to compare and analyze the advantages,disadvantages,opportunities and threats of individual account and outpatient coordination.By learning from international experience and predicting the impact of the reform,it is recommended to improve outpatient guarantee from treatment policy convergence,payment method reform,service supervision and monitoring,and outpatient service supply.
作者
李欣芳
薛清元
张立强
LI Xinfang;XUE Qingyuan;ZHANG Liqiang(National Institute of Healthcare Security,Capital Medical University,Beijing 100037,China;不详)
基金
国家自然科学基金资助项目“基于灰色建模技术的民族地区居民基本医疗保险统筹预测研究”(72064032)
中华中医药学会青年求实项目“医保相关政策与中医药行业发展研究”(2022-QNQSJGL-0102)。
关键词
职工医保
个人账户
门诊保障
employee medical insurance
individual account
outpatient guarantee
