医疗保险与医疗救助:理论、现实与政策
|
摘要
医疗救助与医疗保险是我国医疗保障体系的主要组成部分。二者管理职能的整合有利于实现经办服务的连续性与一体化,提高公共服务的效率;但是,二者的整合并不意味着两个制度的合并,也不意味着二者资金的混用以及功能的混淆。在恪守医疗救助与医疗保险各自功能的前提下,整合主要着重于管理与经办服务的有效衔接,利用医疗保险比较成熟的管理与信息网络,优化医疗救助资格认定、申报、审核的流程,实现医疗救助"一站式"结算,将医疗救助资金纳入到医疗保险协议定点管理中,提高医疗救助资金的使用效率。
Integration of the administration of medical insurance and medical assistance,which consists the two main parts of China's medical security system,will improve continuity and unification of the management and service of the two schemes,so to promote system efficiency.However,the administrative integration does not imply to merge the two schemes as one,since its' principle,nature,and characteristics are different,as well as they have different responsibilities.Thus,the focuses of administrative integration are on connecting of management and service of the two schemes under the premise of their responsibilities.It is suggested to optimize the process of recognition on the qualification of beneficiaries as well as the process of declaration and examination by using the mature service and management network of social insurance.On the other hand,the mechanism of "one-stop"service of settlement of medical fees for these beneficiaries of medical assistance should to be built,and the fund of medical assistance need to be managed with the medical insurance fund together in order to promote the fund efficiency.
Integration of the administration of medical insurance and medical assistance,which consists the two main parts of China's medical security system,will improve continuity and unification of the management and service of the two schemes,so to promote system efficiency.However,the administrative integration does not imply to merge the two schemes as one,since its' principle,nature,and characteristics are different,as well as they have different responsibilities.Thus,the focuses of administrative integration are on connecting of management and service of the two schemes under the premise of their responsibilities.It is suggested to optimize the process of recognition on the qualification of beneficiaries as well as the process of declaration and examination by using the mature service and management network of social insurance.On the other hand,the mechanism of "one-stop"service of settlement of medical fees for these beneficiaries of medical assistance should to be built,and the fund of medical assistance need to be managed with the medical insurance fund together in order to promote the fund efficiency.
引文
[1]巴尔.福利国家经济学[M].北京:中国劳动社会保障出版社,2003.
[2]民政部.2017年社会服务发展统计公报[R].北京:民政部,2017.
[3]乌日图.社会保障顶层设计亟待明确的三大问题[J].社会保障研究,2018(03):3-14.
[2]民政部.2017年社会服务发展统计公报[R].北京:民政部,2017.
[3]乌日图.社会保障顶层设计亟待明确的三大问题[J].社会保障研究,2018(03):3-14.