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山東省居民基本醫療保險籌資現狀與改進對策

Financing status and countermeasures of basic medical insurance program for residents in Shandong Province

作者:

時濤   吳敏   韓志琰   蘇君

單位:

濟南,山東第一醫科大學(山東省醫學科學院)醫療保障學院(時濤、吳敏、韓志琰);濟南市第四人民醫院醫保辦(蘇君)

關鍵詞:

居民;基本醫療保險;省級統籌;籌資;山東

分類號:

R19; F840.684

DOI:10.3969/j.issn.2095-7432.2023.01.007

出版年,卷(期),頁碼:2023,13 (1):40-44

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摘要:

目的 比較山東省16地市居民基本醫療保險籌資政策的差異,探討推進省級統籌的籌資政策建議。方法 進行政策文本分析,比較不同地市在居民基本醫療保險的籌資模式、籌資標準、約束激勵措施等方面的差異。結果 山東省居民基本醫療保險籌資以固定等額籌資模式為主,政府財政補助轉移支付為普惠性轉移支付,現有的籌資機制對弱勢群體的照顧不足,籌資的激勵約束機制不健全。結論 建議建立與區域經濟發展水平相適應的籌資機制,建立財政補貼與繳費年限相關聯的激勵約束機制。

英文摘要:

Objective To compare the differences in the financing policies of basic medical insurance program for residents in 16 cities in Shandong Province and explore the solutions for promoting provincial-level planning of financing policies. Methods By analyzing the policy texts, we compared the differences in financing models, fi nancing standards, and constraints/incentives of basic medical insurance programs in different prefectures and cities. Results The financing for basic medical insurance programs for residents in Shandong Province is mainly based on the fi xed equal amount fi nancing mode. Since the government fi nancial subsidy-based transfer payment is an inclusive transfer payment, the existing fi nancing mechanism does not pay special attention to vulnerable groups and the incentive/constraint mechanisms of the financing is suboptimal. Conclusions It is recommended to establish a financing mechanism that is compatible with the level of regional economic development and to establish an incentive/constraint mechanism related to financial subsidies and payment years.

基金項目:

山東省社會科學規劃項目“深化醫藥衛生體制改革問題與對策研究”(21AWTJ08);山東省醫療保障局委托課題“《山東省深化醫療保障制度改革的實施意見》的研制與修訂”;濟南市醫保局委托課題“濟南市醫保大數據基金監管創新項目”(202101

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