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[目的]总结和分析重庆市在医疗保障城乡统筹实践探索中的经验。[方法]选取重庆市九龙坡区城乡居民合作医疗保险管理中心作为现场进行实证调查。收集医疗保险城乡统筹前后有关的政策文件和报表数据与参保人员的信息等。[结果]农村居民财政补助资金未及时到位;补偿比例、封顶线设置较低,起付线设置较高;基金使用率较低;补偿基金主要流向基层医疗机构;获得住院补偿的参保居民总体的受益率仅6.06%左右,且Ⅰ档和Ⅱ档之间受益情况差异较大。[结论重庆市在实践探索中已取得的成果和存在的问题:打破身份界限,统一城乡居民医疗保险待遇标准;整合现有资源,统一城乡医疗保险经办操作;促进了基层医疗资源的有效利用;政府财政投入未能及时到位,实际报销比例较低;基金沉淀问题;统筹层次较低,“穷帮富”的现象较为突出。
[Objective] To summarize and analyze the experience of Chongqing in exploring and exploring medical insurance in urban and rural areas. [Method] The urban and rural residents’ cooperative medical insurance management center in Jiulongpo District of Chongqing was selected as the site for empirical investigation. Collect medical insurance before and after the co-ordination of urban and rural policy documents and reporting data and insured staff information. [Results] The financial subsidies for rural residents did not arrive in time; the proportion of compensation was lower, the cap-line was lower, the setting of pay-off line was higher, the fund utilization rate was lower, the compensation fund mainly went to primary medical institutions, and the total insured residents The rate of benefit is only about 6.06%, and there is a big difference between the benefits of the first gear and the second gear. [Conclusions] Chongqing has made achievements and existing problems in practice exploration: Breaking the boundaries of identities, unifying urban and rural residents’ standard of medical insurance treatment, integrating existing resources, unifying the operation of urban and rural medical insurance, and promoting the effective utilization of primary medical resources ; Government financial investment failed to put in place in time, the actual reimbursement ratio is low; the problem of fund precipitation; overall planning level is low, “poor help rich ” phenomenon is more prominent.