少数民族地区城乡医疗保险一体化研究文献综述

本文在归纳普遍性和广泛性的城乡医疗保险一体化研究现状的基础上,对民族地区城乡医疗保险制度研究现状做了文献综述。通过对比简要分析了少数民族地区城乡医疗保险一体化研究现状和研究方向,为民族地区医保一体化研究进一步探明方向。

从“新农合”到“农村医保”加“合作医疗”——建立城乡一体化医疗保险制度的设想

新型合作医疗制度的实施,为解决农民看病难,看病贵,农民因病致贫,因病返贫直到了重要作用,原来筹资水平低、报销水平低,报销手续复杂,定点医疗机构监管难等问题都比过去有了较大的改观。但新型农村合作医疗制度本身还存在一些深层次的问题,如管理成本高,管理机构体制不畅,"参合"政策的自愿性与实际"参合"的半强制性的矛盾等依然存在。解决"新农合"制度深层次的问题,实际上就是向建立城乡一体化的医疗保险制度的终极目标迈进。为此,要继续深化现行的新型农村合作医疗制度改革,建立起农村大病医疗保险和门诊小病的合作医疗制度。

城乡医保一体化下新型农村合作医疗住院患者费用流向实证分析

目的:通过分析城乡医保一体化模式下,2012—2014年长春市朝阳区新型农村合作医疗住院患者的就诊和医疗费用流向情况,探讨存在的主要问题并提出相应的对策。方法:对2012—2014年长春市朝阳区新型农村合作医疗患者在各级医疗机构的住院人次构成比、次均住院费用、次均个人自费和基金使用构成比等进行比较。结果:2012—2014年分流到省级和市级医院的住院人次、费用和新型农村合作医疗补偿费用逐年增加,2014年省级和市级医院住院人次分别为38.11%和42.51%。2012—2014年各级医院住院人次由高到低依次为市级、省级、区级和乡级。参合农民次均住院费用和次均个人自费由高到低依次为省级、市级、区级和乡级医院。2012—2014年新型农村合作医疗基金分流数额由高到低依次为省级、市级、区级和乡级医院。结论:城乡医保一体化模式下,长春市朝阳区参合农民的住院人次、住院费用和住院补偿费用分流到区级和乡镇级医院的比例逐年减少,次均住院补偿比在省级医院最高。

Literature review of the basic medical insurance of urban and rural integration

To set up the nation＇s covering medical insurance syslem and to the realization of the basic medical insurance of urban and rural integration, is the inevitable trend in the development of China＇s medical insurance reform, as well as it is also a key step. In recent years, the state promulgated a series of policies in promoting urban and rural medical insurance and many cities took the lead to reform form the medical insurance pattern with local characteristics. All of these are helpful for our country to realize the integration and providing valuable experience. The target of the article is to maintain the public cause of medical and health, to solve the problem of high cost of urban and rural residents to see a doctor. As well as to realize the objections of disease pro^ection, convenience, cure spends less.

A Thought About the Integration of Urban and Rural Medicare

Presently, Chinese urban and rural medicare systems differ from each other in many aspects including coverage, payment, and funding patterns, etc, which accounting mainly for the serious situation of the division between urban and rural areas, among different areas and among different communities. The paper will firstly illustrate the purposes and principles of integrating urban and turn/medical insurance systems. Then, with the development of socialist core value--equity, the consideration of the development of the social security system, and the consideration of the strengthening of the rural and urban economy, integrating three main basic health insurance systems is required to take place urgently, In the last part, it provides the strategic development of the inter,ration of the dual svstem.so as to build an uniform social insurance system.