我国城镇职工医保基金收支运行的政策建议.docVIP

随着经济的不断发展和新一轮医疗制度改革的不断深化，城镇职工医疗保险 慕金的收支平衡在整个社会保障体系中扮演着越来越重要的角色。如何合理高效 地运用职工医保基金，保证收支平衡，不仅与居民生活和健康水平息息相关，更 对我国医疗保障制度的完善影响深远。本文以数据统计分析和案例研究法为主， 围绕我国城镇职工医疗保险基金收支运行中的效率和平衡问题展开。从职工医保 基金的概念开始，本文详细介绍了城镇职工医保制度和职工医保基金的含义。然 后从收入，支出和基金管理三方而入手，结合历年数据，对我国职工医保基金收 支平衡进行分析，发现近年来我国职工医保基金收支中存在的问题。最后以上海 市为例，通过数据分析，深入研究其医改过程中以总额预付制为中心，多种偿付 方式并存的改革实践的积极和消极效应。并为我国医改提出意见建议。 关键词：职工医保基金 收支平衡 总额预付制 With the continuous development of economics and the accelerating process of health care reform in China, the balance of medical insurance funds for urban workers has been playing an increasingly crucial role in the whole social welfare system. How to use the funds effectively and efficiently is not only closely related to peoples health level and daily life, but also has a profound impact on the wellbeing of China^s medical system. By case study method and data analysis, this thesis focuses on the efficiency of the usage of medical insurance funds and the balance between income and expenditure. Firstly, it introduces the concept of medical system in China, as well as that of medical insurance funds. Secondly, from the perspective of income, expenditure and funds management respectively, it analyzes the historical data in recent years to find out the potential problems in the process. Taking Shanghai as an example, the article then studies on both positive and negative effects of Shanghai^ reform, which is cored on total prepaid system and supplemented with other modes of payment, and finally tries to provide policy suggestions to the public. KEY WORDS: medical insurance funds for urban workers balance between income and expenditure total prepaid system 我国城镇职工基本医疗保险基金收支平衡性研究 以上海市为例 城镇职工慕本医疗保险制度作为我国社会保障制度的重要组成部分，在整个 社会保障体系中扮演着保障职工身体健康，抵御疾病风险，促进劳动力再生产经济持续发展的重要角色。城镇职工医疗保险制度有效运行的关键在于其医疗保险 基金长期的收支平衡。职工医疗保险制度运行十余年来，本着“收支平衡，略有 结余”的冃标，医保基金的筹集，管理，运行过程不断完善。2009年《医药卫 生体制改革近期重点实施方案（2009-2011年）》（即新医改方案）出台，提出“加 快推进基本医疗保障制度建设,提髙保障水平，逐步提高住院报销比例，扩大门诊 报销范围和提高报销比例;规范基金管理，合理控制结余”的要求，全国各地纷 纷因此扩大了医疗保险报销范围，提高了报销水平。随之，