居民医保筹资增长与保障待遇变化比较研究——以某省城镇居民医保基金运行情况为例

A comparative study of the growth of health insurance financing and changes in insurance benefits ——Taking the operation of health insurance fund for urban residents in a province as an example

目的通过对医保筹资增长与待遇水平变化进行比较,分析医保筹资增长与保障待遇变化的关系,并针对存在的问题,提出相应对策。方法对2013-2017年某省城镇居民医保筹资标准、基金收入、支出、结余与医保待遇变化进行对比分析。结果 2013-2017年个人缴费由60元增长至180元,基金五年增幅达到129.11%,结余基金可支付的月数约为2.65个月;平均基金支付比例为64.84%,五年增长率为2.96%;平均基金支付住院费用的比例为65.99%,五年增长率为4.31%。主要原因在于医疗费用持续上涨、医疗消费结构不合理、医保基金作用被夸大、医保政策调整相对滞后。结论医保筹资的大幅增长,并未大幅提高参保人医保待遇。建议改革医保支付方式、明确医保功能定位、完善医保保障政策和加强医保基金监管。

Objective To compare the growth of health insurance financing and the changes in insurance benefits,to analyze their relationship and to put forward the corresponding countermeasures for existing problems.Methods Contrastive analysis was made of the financing standard,fund income,expenditure,balance and the changes in insurance benefits of urban residents in a province of China from 2013 to 2017.Results The individual contribution increased from 60 yuan to 180 yuan from 2013 to 2017,the five-year growth rate of the fund reached 129.11%,and the number of months for the balance fund to be paid was about 2.65 months.The average fund payment rate was 64.84%,with a five-year growth rate of 2.96%.The average fund payment rate for hospitalization was 65.99%,with a five-year growth rate of 4.31%.The main reasons were the continuous rise in medical expenses,irrational structure of medical consumption,exaggerated role of health insurance fund,and relatively lagging adjustment of health insurance policies.Conclusions The substantial increase in health insurance financing has not substantially improved the benefits of the insured.It is suggested to reform the payment mode of health insurance,clarify the functional orientation of health insurance,perfect the health insurance policies,and strengthen the supervision of health insurance fund.