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随着医疗保险覆盖面的迅速扩大,以及人们对医疗保障需求的日益提高,医疗保险基金支付能力面临压力。为保证医疗保险制度的健康发展,医疗保险基金的平稳运行,有必要对参保人员住院医疗费用情况作进一步分析,对医疗保险基金支出的方向、结构、数额做到有效把握和控制,实现基金的良性运行和有效使用,确保医疗保险制度的可持续发展。我省医疗保险制度1999年开始建立,2000年各地相继制定方案,2001年大部分统筹地区启动,而真正全面推开,具备完整年度医疗保险数据是从2002年开始的。因此,下文选择2002年度作为起点,通过对2002至2005年四年来全省医疗保险住院医疗情况的分析,掌握了全省参保人员住院医疗的一些特点和规律,发现了基金支出运行方面存在的问题,为确保基金健康平稳运行,提出了在积极扩面过程中,要坚持稳健筹资,建立健全“三个体系”,打造“数字”医保,探索多种定点方式,多渠道控制不合理费用增长,加快医疗保险立法的建议。
With the rapid expansion of medical insurance coverage and the increasing demand for medical insurance, the ability to pay medical insurance funds is under pressure. In order to ensure the healthy development of the medical insurance system and the smooth operation of the medical insurance fund, it is necessary to make further analysis on the hospitalization medical expenses for the insured persons, to effectively control and control the direction, structure and amount of the medical insurance fund expenditure and realize the fund The healthy operation and effective use of medical insurance system to ensure the sustainable development. The medical insurance system in our province started to be established in 1999. In 2000, all localities have formulated their own plans. In 2001, most of the co-ordinating regions started their work. However, the medical insurance system in our province was launched in full swing. Data on the complete annual medical insurance have been available since 2002. Therefore, the following selected 2002 as a starting point, through the analysis of medical insurance in the province’s medical insurance in the four years from 2002 to 2005, we have mastered the characteristics and laws of inpatient medical services in the province and found that the fund expenditure operation In order to ensure the healthy and stable operation of the Fund, it was proposed that in the process of positive expansion, we should steadily raise funds, establish and improve the “three systems”, create “digital” medical insurance, explore various fixed-point methods and control the growth of unreasonable expenses through various channels , To speed up the medical insurance legislation proposal.