[1]黄 薇,朱晓丽.我国职工医保门诊共济保障政策分析及优化[J].卫生经济研究,2023,40(1):49-52.
　HUANG Wei,ZHU Xiaoli.Analysis and Optimization of Outpatient Co-Payment Protection Policy of China's Employee Medical Insurance[J].Journal Press of Health Economics Research,2023,40(1):49-52.
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我国职工医保门诊共济保障政策分析及优化
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
40
期数:
2023年1期
页码:
49-52
栏目:
医疗保障
出版日期:
2023-01-06

文章信息/Info

Title:
Analysis and Optimization of Outpatient Co-Payment Protection Policy of China's Employee Medical Insurance
作者:
黄 薇1; 朱晓丽2
1.四川省医学科学院·四川省人民医院卫生政策与医院管理研究所，四川 成都 610072
2.中国医学科学院医学信息研究所卫生政策与管理研究中心， 北京 100020
Author(s):
HUANG Wei;  ZHU Xiaoli
Department of Health Policy and Hospital Management Research, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu Sichuan 610072, China
关键词:
职工医保; 门诊共济保障; 统筹基金
Keywords:
employee health insurance;  outpatient co-payment protection;  pooling fund
分类号:
R19；F684.840
文献标志码:
A
摘要:
目的：从医保统筹基金保障水平、个人账户计入和适用范围、支付方式改革三个方面分析我国30个省（区、市）职工医保门诊共济政策。方法：系统收集和梳理各地职工医保门诊共济相关政策文件，基于内容分析法提炼共性和差异。结果：各地普通门诊统筹保障水平差异较大，保障均等化水平较低，多数地区普通门诊支付方式尚未明确具体操作指南，未与医疗服务体系协同。结论：优化门诊统筹基金支付方案，完善门诊统筹协议管理；加强门诊支付方式顶层设计，明确基于价值的医保支付方式改革方向；加强与医疗服务体系的协同，拉大不同级别医疗机构报销比例。
Abstract:
Objective To analyze the policies on outpatient co-payment of employees' medical insurance in 30 provinces (autonomous regions and municipalities) in China from three aspects, namely, the level of protection of the medical insurance coordination fund, the crediting and application scope of individual accounts, and the reform of payment methods. Methods This study systematically collected and sorted out the policy documents related to outpatient co-payment of employees' medical insurance in different regions, and extracted the commonalities and differences based on content analysis. Results The level of protection for general outpatient co-ordination varied widely across regions, and the level of protection equalisation was low. Most regions have not yet defined specific operational guidelines for general outpatient payment methods, and have not coordinated with the healthcare service system. Conclusion It is suggested to optimize the outpatient co-ordination fund payment scheme and improve the management of outpatient co-ordination agreements, strengthen the top-level design of outpatient payment methods and clarify the direction of value-based health insurance payment reform. It is recommended to strengthen the synergy with the health service system and widen the differences in reimbursement ratios between different levels of medical institutions.

参考文献/References:

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更新日期/Last Update: 2023-01-06