城镇职工医疗保险运行中存在的问题与对策

通过对我国城镇职工医疗保险制度改革的实施过程的回顾,深入分析了新的医保制度在筹资、基金管理、费用结算和基金收支方面存在的问题,以及产生这些问题的原因。对进一步改革、完善城镇职工医疗保险制度,提出了几点政策建议,包括:确定合理的基金筹集比例,建立与社会经济发展水平和居民消费意识相适应的基金管理模式,探索有利于卫生服务供需双方的费用支付方式,以及制定适宜的医疗保障水平。

The Problems and Policy Recommendations to Health Insurance Reform in Urban China

By reviewing the process of health insurance reform in urban China, the authors analyze the problems in such aspects as financing, fund management, payment for medical expense and insurance fund income and expenditure, and discuss the causes of these problems. Then, the authors put forward some policy recommendations to reform and improve urban health insurance system. These recommendations include: to identify a rational financing level, develop a reasonable fund management model corresponding to socioe-conomic development and people's conception of medical consumption, explore a way of medical expense payment benefiting both sides of health provider and consumer, and establish a feasible medical entitlement.