统筹城乡医疗保险制度模式比较分析

在当前统筹城乡发展的大背景下,许多地方开展了统筹城乡医疗保险制度的探索,形成了"社保部门主管""、卫生部门主管""、社保部门和卫生部门合作管理"三种模式。其中多数地区由社保部门主管,并在此模式下又表现出"五险合一统一经办管理"、"医保机构分设经办管理""、商业保险参与经办管理"三种形式。不同模式在主管部门、经办机构、统筹层次、覆盖范围、筹资标准、待遇水平及保障范围上各不相同,形成各自的特色。通过比较分析,提出统筹城乡医疗保险制度建设并不以经济发展水平为前提,应当统一管理体制,提高统筹层次,科学设计适应当地情况的城乡居民基本医疗保险制度,完善城乡医疗保险信息化管理系统和信息网络平台。

Comparative Analysis of Medical Insurance System for Rural and Urban Residents

With the background of bridging urban-rural gap,three models are formed: managed by health department,managed by social security department and cooperation management.The basic medical insurance system for rural and urban residents is managed by social security department in most areas.The competent department,handling organizations,overall plan level,coverage,financing standard,treatment level and security scope vary in different models.By comparative analysis,some suggestions are provided.The basic medical insurance system for rural and urban residents is not predicated on the level of economic development.The management system should be unified and the level of overall planning should be raised.The systems should be scientific designed in accordance with actual situation.The information management system and information network platform should be improved.