城乡居民基本医疗保险制度整合与完善

整合城乡居民基本医疗保险制度是建立更加公平可持续的全民医保制度的必然要求和基础条件,是我国医保制度发展与完善的必经之路。虽然部分地区在整合中取得了一定的成就,但是仍存在诸多问题：政策的不明确导致管理体制混乱,医疗卫生资源配置不均衡导致整合后的不公平,待遇的“就高不就低”取向会对医保基金产生一定的压力,缴费方式的选取不慎会影响制度的可持续和社会的稳定,“两定”的整合和分级诊疗的不完善导致大医院的压力增加等问题。因此,需要理顺城乡居民基本医疗保险制度整合的管理体制,注重城乡居民医保基金的开源节流和保值增值,推进医疗卫生资源的合理配置,增强对同质医疗卫生资源的可及性,选择适合各地地情的缴费方式,实现制度的平稳过渡,加快分级诊疗的实施进度,减轻大医院的就医压力。

Problems and Countermeasures of Integration of Urban and Rural Basic Health Insurance

Integration of urban and rural basic health insurance systems is the basic condition necessary for establishing a more equitable and sustainable system of universal health cares, and also is the pass of the development and improvement of China''s health insurance system. While some areas have made achievements in the integration, there are still many problems. Policy uncertainty will lead to confusion of management system; Unbalanced allocation of medical resources will result in unfairness consolidated; the orientation of choosing high treatment will produce a certain pressure; the inadvertent choice of payment method will affect the system sustainable and social stability; "Two fixed" integration and imperfections of classified diagnosis and treatment will increase the pressure on big hospitals. Therefore, we need to rationalize integrated management system of the basic medical insurance system for urban and rural areas; focus on increasing the value of urban and rural residents and cut costs; promote the rational allocation of medical resources, and enhance the homogeneity of health-care resources availability; choose the payment method suiting to the situation and achieve a smooth transition; accelerate the implementation schedule of classified diagnosis and treatment, and reduce the pressure of the big hospitals.