从“县级统筹”到“市级统筹”:医保制度统筹层次问题探析——以广西H市F县的新农合制度为例

Analysis of the Medical Insurance System from the County-level Unified Management to the City-level Unified Management:A Case Study of County F in City H,Guangxi Province

统筹层次是医保制度的重要组成部分,对医保制度的良性运行具有重要意义。目前,全国各地都在探索将城乡居民医保制度的统筹层次从县级提高到市级,在实践过程中遇到了不少困难。通过实地考察研究发现,“县级统筹”虽然曾经发挥了重要作用,但是随着经济社会的发展,统筹层次过低的弊端日益明显;而“市级统筹”的探索虽然在一定程度上克服了“县级统筹”的弊端,但是其自身也存在着一些值得注意的深层次问题。因此,在提高城乡居民医保制度的统筹层次之后,县级层面的激励将是市级统筹面临的核心问题,应予以高度重视。

Unified management at all levels is an important part of medical insurance system and is of great significance for the positive operation of medical insurance system.Currently,governments across the country are exploring to raise the unified management of medical insurance system for urban and rural residents from county level to city level,which encounters difficulties in practice.Surveys show that although countylevel unified management of medical insurance system has made great contributions,with the development of economy and society,its disadvantages are becoming more and more obvious;meanwhile,although citylevel unified management of medical insurance system avoids the problems of county-level management,it also has its own problems.Therefore,after raising the level of unified management,the county-level incentive mechanism will be the core issues faced by the city-level unified management,which should be placed importance.