医保基金结余现状分析与大病保险筹资标准及保障水平研究.pdfVIP

口医疗保障 《 中国卫生经济》 第 32 卷第 5 期(总第 363 期) 2013 年 5 月 医保基金结余现状分析与大病保险筹资标准及保障水平研究* 吴维民①，杨秀玲①，张莉②，蒋帅①，范丽①，韦波③ 摘 要 目的:了解基本医保基金结余和病人个人负担情况，提出建立大病保险的建议。方法:采用描述统计分析方法 分析基金结余和病人负担情况。结果:政策范圈内报销比例与实际报销比例差距辍大，个人负担重与基金箱余过多并存。结 论:应避-步披大医保基金保.效用.实行大病保险，提高实际报销比例，Jl轻医保病人个人负担。 关键词 医保基金;大病保险;筹资标准;保障水平 中图分类号 R1-9; R197 文献标识码 A 文章编号 1 ∞3-0743(2013)0ι∞4ι04 DOI 10.76创ICH 飞 11 ，， 1 、川、 01 \kdiral 111、lI ran飞( FlIncl Balanll日lallll and 刊tllcl、 011 Finanlin且只七IIlclard and Sll uril、I.l 、lI of 川r、 (IT J)iSl a~I I n、11 ra1Itt，j\飞 t 飞飞。 li- l11 in‘ 飞 飞 N(; \iu-lin旦. χIL飞 \(; Li. d al./l(hil1l吨l I flallh Econol1lÌl:飞 .WI.D.:!(SJ: .ló-..JIJ .\ Ihlrarl Oh.il,(.ti\l: To understand the statue of basic medical insurance fund balance and the individual burden of patien恼， and proposes severe dise岱e insurance. Metb创s: Descriptive statistics analysis method was employed to analyze fund balance and individual burden. R臼ults: It has a large gap between the reimbursement proportion within the range of policy and the practical reimbursement proportion of hospitalization expenses. The individual burden is heavy while the fund balance is overmuch. Conclusions: It should give full play to 由e role of medical insurance, implement the severe disease insurance, improve practical reimbursement proportion，陀duce individual burden of medical insur亩nce. lú~ \\ord、 medical insurance fund; severe disease insurance; financing standard; security level F训ir、叶1-斗;刊t川11川t川川t忖l阳10町)r 、 :叫1ωd仇ωdr川.~ ((川)11川.飞t叩川川I(【dωlil吨E吆旦 ;泊川川11川11 1山h川t川盯)r WE囚1 B阮0 ， E-mail: weibogx@163.com 职工医保、城镇居民医保和新型农村合作医疗保险 2 结果 2.1 基本医保基金使用与结余情况 (以下简称新农合)实际报销比例与政策范围内报销比