基于组态视角的基本医保省级统筹影响因素分析

Analysis of the Influencing Factors of Provincial Financing of Basic Medical Insurance in View of Configuration

目的:基于组态视角,探究影响基本医保稳步推进省级统筹的最佳条件组合,剖析影响基本医保推进省级统筹的多重并发因果关系及多元路径,为没有实现省级统筹的省(自治区)提供参考。方法:运用模糊集定性比较分析推进省级统筹各因素间的联动关系。结果:基本医保市级统筹是否全面做实对稳步推进省级统筹影响较大,市级统筹是否做实的一致性比例达到0.97,市级统筹全面做实是推进省级统筹的必要条件。推进省级统筹的路径共有四条,其中职工参保人数、当期基金征缴收入、基金累计滚存结余、做实市级统筹的条件组合能够解释总案例的12%,在实践中已经实现省级统筹的地区中有四个地区符合这一路径,占全部已经实施省级统筹的50%。结论:推动省级统筹,还需要全面总结市级统筹的经验做法,循序渐进推进省级统筹,提升政策协同效应,结合地区特点制定医保政策,建立专门的医保基金监管专职机构,在全面做实市级统筹上下足功夫,确保省级统筹稳步落地。

Objective To explore the optimal combination of conditions affecting the steady promotion of provincial pooling of basic medical insurance based on the perspective of configuration,analyze the multiple concurrent causal relationships and multiple paths affecting the promotion of provincial pooling of basic medical insurance,and provide references for those provinces(autono⁃mous regions)having not achieved provincial pooling.Methods Fuzzy set was used to analyze the linkage relationship among the factors of provincial overall planning.Results Whether having municipal pooling of basic medical insurance has a great impact on the steady promotion of provincial pooling.The consistency ratio of whether the municipal pooling has fully implemented reaches 0.97,which is a necessary condition for the promotion of provincial pooling.There are four ways to promote provincial pooling.Among which,the combination of the number of employees participating in the insurance,income collected and paid from the current fund,accumulated and rolled-over balance of the fund,and the realization of municipal pooling can explain 12%of the total cases.A⁃mong the regions which have realized provincial pooling in practice,four regions meet this path,accounting for 50%of all the re⁃gions.Conclusion To promote the provincial pooling,it is necessary to comprehensively summarize the experience and practices of municipal pooling,promote provincial pooling step by step,enhance policy synergy,formulate medical insurance policies based on regional characteristics,and establish specialized medical insurance fund supervision institutions.