职工医保门诊共济保障政策分析与优化

Policy Analysis and Optimization of the General Employee Medical Insurance Outpatient Co-payment Security Mechanism

建立健全职工医保门诊共济保障机制是党中央、国务院深化医疗保障制度改革的重要任务,也是惠及3.6亿参保职工的重要民生福祉。我国于2021年全面启动职工医保门诊共济保障改革,为探究各地改革前后门诊共济保障政策在具体补偿模式、标准上的共性与差异,特以全国31个省级行政区和改革前已探索实施职工门诊统筹的33个市级行政区为研究对象,横向、纵向比较职工医保普通门诊统筹和门诊慢特病保障政策。分析发现为进一步推动职工医保门诊共济保障改革,可以从强化费用保障、实现健康保障、促进协同保障三方面着手优化和推动改革政策落地。

Establishing and improving the general employee medical insurance outpatient co-payment security mechanism is an important task assigned by the Party Central Committee and the State Council to deepen the reform of the medical insurance system,and it is also a major benefit for 360 million participating employees.In 2021,China comprehensively launched the reform of general employee medical insurance outpatient co-payment security.In order to explore the similarities and differences in specific compensation models and standards of outpatient co-payment security policies before and after the reform in various regions,this study took 31 provincial-level administrative divisions across the country and 33 municipal-level administrative divisions that had explored and implemented employee outpatient co-payment security before the reform as the research objects,and compared the policies of general employee medical insurance outpatient co-payment security and outpatient chronic special diseases security horizontally and vertically.It is found that to further promote the reform of general employee medical insurance outpatient co-payment security,optimization and promotion of reform policies can be achieved in three aspects:strengthening cost security,achieving health security,and promoting collaborative security.