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威海市曾于1997年4月启动了“两江模式”的医改试点。去年5月,在试点工作的基础上,威海市按照国务院《关于建立城镇职工基本医疗保险制度的决定》,制定出台了医疗保险新办法。经省政府批准,去年5月1日启动实施。从一年来的运行情况看,效果良好。(一)扭转了医保基金收不抵支的局面。以前的试点,由于管理方法等方面的原因,导致全市医疗保险费收不抵支,统筹基金亏2900多万元。新办法运行一年来,共收缴医疗保险费12378万元,支出9957万元,结余1910万元,实现了收支平衡、略有结余。与1998年相比,收费增加2043万元,增长19.7%,医疗费支出减少3462万元,减少25.7%。(二)职工基本医疗需求得到有效保障。全市参加基本医疗保险的单位3762个,参保职工21.36万人,单位和职工参保率分别达到69%和68%。全市共有定点医疗机构262个,其中住院定点医院86个。
Weihai City in April 1997 launched a “two-river model” of medical reform pilot. Last May, on the basis of the pilot work, Weihai City formulated and promulgated a new approach to medical insurance in accordance with the Decision of the State Council on Establishing the Basic Medical Insurance System for Urban Workers. Approved by the provincial government, launched on May 1 last year. From the operation of the past year, the effect is good. (A) reversed the situation of non-payment coverage of Medicare funds. The previous pilot, due to management methods and other reasons, led to the city’s medical insurance fees are not covered, the overall fund loss of more than 2900 million. Over the past year since the new measures were put into operation, a total of 123.78 million yuan of medical insurance fees were collected, with an expenditure of 99.57 million yuan and a balance of 19.1 million yuan, achieving a balance of payments with a slight surplus. Compared with 1998, fees increased by 20.43 million yuan, an increase of 19.7%, medical expenses decreased by 34.62 million yuan, a decrease of 25.7%. (B) the basic medical needs of workers have been effectively protected. The city’s 3762 basic medical insurance units, insured employees 213,600, units and workers insured rates reached 69% and 68%. The city has a total of 262 designated medical institutions, of which 86 are designated hospital hospitals.