新型农村合作医疗大病保险省级统筹探讨.pdfVIP

口合作医疗 《中国卫生经济》第33卷第10期(总第380期) 2014年10月 新型农村合作医疗大病保险省级统筹探讨* 段沁江①，徐芬①，王宁①，钱东福② 摘 要 目的:分析新型农村合作医疗大病保险统筹层次的现状和趋势。方法:医疗保险基本理论。结果:囱于医疗监 管、财政体制和运行成本等原因，市和县级统筹存在重大缺陷，难以保证制度有效运行。结论:新型农村合作医疗大病保险 以省级统筹为合理，市、县统事地区应提离统筹层次。 关键词 新型农村合作医疗;大病保险;统筹层次 中国分类号 Rl-9; R197 文献标志码 C 文章编号 1∞3-0743(2014)10-0051-02 001 10.7侃41CHE20141 015 Discussion on the Critical IIIness Insurance at Provincial Level under New Rural Cωperative Medical SystemIDUAN Qin-jiang, X() Fen , WANG Ni吨， et a lJlChinese Health Economics, 2014,33(10):51-52 Abstract Objective: To analyze on the status and trends of critical illness insurance level under new rural c∞perative medical system(NCMS). Methods: The basic theory of medical insurance. Res凶ts: Due to medical supervision, financial system and operating costs, city and ωunty levels had great defects which were difficult to gu缸.ant臼 the system run continuously. Conclusion: NCMS criti- cal iUness insurance at the provincial was reasonable , city and ωunty levels should be raised to provincial level. Key words new rural c∞perative medical system; critical iUness insurance; pooling level First-author s address Department of Health Business Management and Public Health , Jiangsu Health Vocational College, Nanji吨， 21∞29， China 1 l 大病保险的特点分析 村人口的9%-14%( ) 。 1.1 性质 1.4 就诊医院 不同于商业医保和基本医保，大病保险是由政府 病人在县内就诊，或因大病、重病，县内无法救 主导，财政、 居民和保险公司风险共担，减轻群众大 治，转诊到省、市医院就诊的，均可能产生大额费 额费用经济负担的制度安排，具有准公共服务产品属 用。 但次均住院费用随定点医院级别增高而增高，因 性。大病保险不进行风险筛选，其风险保障额度高、 此大病保障对象多产生于省、市医院l飞 风险构成复杂，必须有相当的覆盖人群才能体现保险