[1]李欣芳,薛清元,张立强.完善职工医保门诊保障制度的思考与借鉴[J].卫生经济研究,2022,39(12):41-44.
　LI Xinfang,XUE Qingyuan,ZHANG Liqiang.Thinking and Reference of Improving the Outpatient Guarantee System for Employee Medical Insurance[J].Journal Press of Health Economics Research,2022,39(12):41-44.
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完善职工医保门诊保障制度的思考与借鉴
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
39
期数:
2022年12期
页码:
41-44
栏目:
医疗保障
出版日期:
2022-11-24

文章信息/Info

Title:
Thinking and Reference of Improving the Outpatient Guarantee System for Employee Medical Insurance
作者:
李欣芳1; 薛清元2; 张立强1
1.首都医科大学国家医疗保障研究院，北京 100037
2.内蒙古医科大学卫生管理学院，内蒙古 呼和浩特 010110
Author(s):
LI Xinfang;  XUE Qingyuan;  ZHANG Liqiang
National Institute of Healthcare Security, Capital Medical University, Beijing 100037, China
关键词:
职工医保; 个人账户; 门诊保障
Keywords:
employee medical insurance;  individual account;  outpatient guarantee
分类号:
R19；F840.684
文献标志码:
A
摘要:
我国职工医保个人账户是特定时期的改革产物，随着医保制度改革深化，职工医保门诊保障由个人积累模式转向社会互助共济模式。运用SWOT分析法，对个人账户和门诊统筹的优势、劣势、机会和威胁进行对比分析，并借鉴国际经验，预判改革带来的影响，从待遇政策衔接、支付方式改革、服务监管监控、门诊服务供给等关键环节提出对策建议。
Abstract:
The individual account of the employee medical insurance in China is the product of the reform in a specific period. With the deepening of the reform of the medical insurance system, the employee medical insurance outpatient guarantee has changed from the individual accumulation mode to the social mutual assistance mode. The SWOT analysis method was used to compare and analyze the advantages, disadvantages, opportunities and threats of individual account and outpatient coordination. By learning from international experience and predicting the impact of the reform, it is recommended to improve outpatient guarantee from treatment policy convergence, payment method reform, service supervision and monitoring, and outpatient service supply.

参考文献/References:

[1] 李烨颍，潘雪雪，吴素雄. 医保“家庭共济”政策的问题与对策[J].卫生经济研究，2022，39（2）：19-22.
[2] 刘朝一，徐伟，许正圆，等.市级统筹背景下城镇职工医保个人账户筹资政策优化研究[J].卫生经济研究，2021，38（3）：40-44.
[3] 付晓光，万泉，柴培培,等.我国职工医保门诊保障的现状及改革思考[J].中国医疗保险，2021（6）：36-38.
[4] 王敏，张开金，姜丽，等.门诊统筹模式的建立与思考[J].中国全科医学，2009，12（7）：538-542.
[5] 朱坤，穆辰，张小娟，等.城镇职工医保个人账户改革效果分析——以江苏省A市为例[J].卫生经济研究，2016，33（2）：5-8.
[6] 郑秉文.医疗保险个人账户改革的动因、方向与步骤[J].中国医疗保险，2020（8）：4-7.
[7] 冯毅.我国门诊统筹“按人头付费”实施现状及改革路径[J].卫生经济研究，2016，33（4）：45-47.
[8] 廖藏宜，蔡文富，李峰，等.门诊按人头打包付费的台州经验及改革成效[J].卫生经济研究，2021，38（12）:47-50.

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更新日期/Last Update: 2022-11-24