无锡市职工基本医疗保险基金可持续运行研究
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摘要
对2011-2015年无锡市职工基本医疗保险基金的运行现状进行分析,发现存在统筹基金收不抵支、个人账户功能弱化、就医流向不尽合理及分解住院等问题,建议优化统筹基金支出结构、完善个人账户制度、推进分级诊疗制度及智能化医疗保险监控系统建设,实现医保基金的安全、高效和可持续运行。
This paper analyzed the current situation of the basic medical insurance fund for employees in Wuxi City from 2011 to 2015, and found some problems including that income is less than expenditure of pool fund, the function of individual account is weakened and the flow of medical treatment is unreasonable and decomposed hospitalization. It is suggested to optimize the structure of fund expenditure, perfect the personal account system, and promote the construction of graded system of diagnosis and treatment and intelligent medical insurance monitoring system, thereby realizing the safe, efficient and sustainable operation of the health insurance fund.
This paper analyzed the current situation of the basic medical insurance fund for employees in Wuxi City from 2011 to 2015, and found some problems including that income is less than expenditure of pool fund, the function of individual account is weakened and the flow of medical treatment is unreasonable and decomposed hospitalization. It is suggested to optimize the structure of fund expenditure, perfect the personal account system, and promote the construction of graded system of diagnosis and treatment and intelligent medical insurance monitoring system, thereby realizing the safe, efficient and sustainable operation of the health insurance fund.
引文
[1]周绿林,李绍华.医疗保险学[M].北京:科学出版社,2013.
[2]林枫,朱梦璐,吴宝林.再谈医疗保险个人账户[J].中国卫生经济,2016,35(2):26-28.
[3]陈励阳.江苏医保智能化监控系统建设进程[J].中国医疗保险,2015,8(9):27-29.
(1)数据来源:人社部《中国社会保险发展年度报告2015》。
(1)“四类五项”数据是无锡市开展的一项基础数据传送工作,包括病种库、医师库、科室和床位等,对推进阳光医保工程建设具有重要意义。
[2]林枫,朱梦璐,吴宝林.再谈医疗保险个人账户[J].中国卫生经济,2016,35(2):26-28.
[3]陈励阳.江苏医保智能化监控系统建设进程[J].中国医疗保险,2015,8(9):27-29.
(1)数据来源:人社部《中国社会保险发展年度报告2015》。
(1)“四类五项”数据是无锡市开展的一项基础数据传送工作,包括病种库、医师库、科室和床位等,对推进阳光医保工程建设具有重要意义。