引用本文：朱坤,张小娟.不同管理体制下城乡居民基本医疗保险运行效果比较
——来自苏州市的实证分析[J].中国卫生政策研究,2013,6(2):8-13 |
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不同管理体制下城乡居民基本医疗保险运行效果比较
——来自苏州市的实证分析 |
| 投稿时间：2013-01-14 修订日期：2013-01-25 PDF全文浏览 HTML全文浏览 |
| 朱坤1, 张小娟1 |
| 中国医学科学院卫生政策与管理研究中心 |
| 摘要:目的：实证分析不同管理体制下城乡居民基本医疗保险的运行效果。方法：以苏州市下辖的常熟市及其他三个县级市作为研究对象，运用描述性统计和比较分析的方法分析城乡居民基本医疗保险运行情况。结果：与其他三个县级市相比较，常熟市参保人员利用市外住院服务比例较低，城乡居民医保住院统筹基金流向市外医疗机构的比例较低，住院补偿受益率相对较高，参保患者的自付住院费用较低，但住院实际补偿比较低。结论：医保的管理体制未对医保覆盖面和基金运行产生明显影响；卫生部门主管有助于更好地坚持“保基本、强基层、建机制”的原则，可以更好地控制医疗费用的上涨速度，减轻患者的医疗负担。建议：进一步扩大医保管理体制改革的试点，为完善我国医保管理体制提供更多的实证依据；同时注重控制医药费用的上涨速度，以降低参保人员的医疗负担；建立健全城乡居民基本医疗保险的评价指标。 |
| 关键词:医疗保险 管理体制 补偿比例 实证分析 |
| 基金项目:中央级公益性科研院所基本科研业务费（11R0202） |
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| Comparative analysis of the operative effect of basic medical insurance for urban and rural citizens under different governance: Empirical analysis from Suzhou |
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| Abstract:Objectives：Empirical study on the operative effect of basic medical insurance for urban and rural citizens under different management systems. Methodology： Changshu and the other three counties of Suzhou city were selected as sample counties and the data of the basic medical insurance for urban and rural citizens in the four counties was analyzed with descriptive statistical analysis and comparative analysis. Results: Compared with the three other counties, the ratio of Changshu enrollees using inpatient service outside counties was much lower. Significantly fewer fund for compensating hospitalization expenditure in Changshu went to medical facilities of the outside counties. The ratio of enrollees getting compensation for hospitalization expenditure is much higher in Changshu. The average hospitalization expenditure is lower, while the actual compensation rate for hospitalization expenditure is higher in Changshu. Conclusions: The coverage and fund of medical insurance were not influenced by governance. Governed by the health authority, the principle of health reform can be better persistently continued and the increasing speed of medical costs can be controlled more effectively. Suggestion: More evidence was needed to improve the governance of medical insurance and so the pilot program should be expanded. The increasing speed of medical expenditure should be controlled and the burden of citizens should be reduced while expanding the pilot program of the reform of governance of medical insurance. Evaluation indicators of medical insurance for urban and rural citizens should be created and developed. |
| Key words:Medical insurance Governance Reimbursement rate Empirical analysis |
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