山东省居民基本医疗保险筹资现状与改进对策
Financing status and countermeasures of basic medical insurance program for residents in Shandong Province
作者:
时涛 吴敏 韩志琰 苏君
单位:
济南,山东第一医科大学(山东省医学科学院)医疗保障学院(时涛、吴敏、韩志琰);济南市第四人民医院医保办(苏君)
关键词:
居民;基本医疗保险;省级统筹;筹资;山东
分类号:
R19; F840.684
DOI:10.3969/j.issn.2095-7432.2023.01.007
出版年,卷(期),页码:2023,13 (1):40-44
摘要:
目的 比较山东省16地市居民基本医疗保险筹资政策的差异,探讨推进省级统筹的筹资政策建议。方法 进行政策文本分析,比较不同地市在居民基本医疗保险的筹资模式、筹资标准、约束激励措施等方面的差异。结果 山东省居民基本医疗保险筹资以固定等额筹资模式为主,政府财政补助转移支付为普惠性转移支付,现有的筹资机制对弱势群体的照顾不足,筹资的激励约束机制不健全。结论 建议建立与区域经济发展水平相适应的筹资机制,建立财政补贴与缴费年限相关联的激励约束机制。
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.
基金项目:
山东省社会科学规划项目“深化医药卫生体制改革问题与对策研究”(21AWTJ08);山东省医疗保障局委托课题“《山东省深化医疗保障制度改革的实施意见》的研制与修订”;济南市医保局委托课题“济南市医保大数据基金监管创新项目”(202101)
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