浅谈城乡居民大病保险医疗费用的管控.pdfVIP

Vo l. 29 No.5 保险职业学院学报{双月刊} 第 29 卷第5 期 JOURNAL OF INSURANCE PROFESSIONAL COLLEGE(Bimonlhly) Oct. 2015 2015 年 10 月 浅谈城乡居民大病保险医疗费用的管控 何冲1 ，吴海波2 ，号剑升3 (1.南京医科大学康达学院，江苏连云港 222000 ;2. 江西中医药大学经济管理学院， 江西南昌 330004; 3. 苏州市中医院，江苏苏州 215003) [摘 要] 城乡居民大病保险试点一年多来，对于解决中低收入家庭因病致贫、因病返贫问延起到了很好的帮扶 作用。但该制度在实施过程中也遭遇了许多困境。其中，承办者商业保险机构亏损严重就是其中之一。追寻亏损的原因 发现，医疗费用上涨过高过快是重要的导火线。本文在分析大病保险医疗费用发展现状和上涨原因的基础上，提出了若干 相应的管控建议，以期有效管控医疗费用的同时实现城乡居民大病保险可持续健康发展。 [关键词] 城乡居民大病保险;医疗费用;管控机制 [文章编号J1673 二1360(2015)05 一0036 一04 [中图分类号JF840.684 [文献标识码JA [Abstract] The pilot project of critical illness insurance for urban and rural residents has been car ried out for more than one year , which has proved a great help in resolving the problems of getting into poverty or returning to poverty for the medium一low income families. While the implementation of the project meet with many difficulties. One of them is the severe deficit of the underwriting commercial insurance organizations. The direct cause of the deficit is that the medical cost is growing too high too fast. This paper analyses the situation of medical cost for critical illness and the r巳ason for the rise of cost and puts forward some suggestions to effectively control and manage the medical cost and maintain a sustainable and healthy development. [Key words] Critical illness insurance for urban and rural residents; Medical cost; Mechanism of management and control 地区全面推开，覆盖人口 3. 6 亿[1] 。本文对大病保 2012 年 8 月 24 日，国家发改委、卫生部、保监 会等六部委联合下发了《关于开展城乡居民大病保 险的医疗费用管控机制提若干参考建议。 险工作的指导意见(以下简称意见) ，明确指出，大 病保