摘要
城乡居民医保整合后必然面临待遇的调整;而待遇调整将对基金支出带来一定影响。如何评估这一影响不仅关系基金的可持续性,而且关系基金的使用效率和参保人的获得感。本文基于浙江某市的调查,分析居民医保待遇调整对基金支出的影响,发现待遇调整后的基金使用效率有待提高。住院待遇提高存在过度医疗的风险,在门诊中提高基层就诊和转诊待遇则可能导致基层出卖转诊权,引致基金浪费。其主要原因在于供方的行政垄断以及由此导致的竞争约束缺乏。
After the integration of medical insurance between urban and rural residents, the benefit adjustment will inevitably be faced, which will bring a certain impact on fund expenditure. And how to evaluate this impact is not only related to the fun sustainability, but also to the e？ ciency of fund use and the acquisition sense of the insured. This paper evaluated the above issue based the survey in one of the areas of Zhejiang, and found that the e？ ciency of fund use need to be improved. The key reason is the administrative monopoly of the supplier and the resulting lack of competition constraint.
出处
《中国医疗保险》
2018年第2期31-34,共4页
China Health Insurance
关键词
城乡居民医保整合
医保待遇调整
基金支出
medical insurance integration between urban and rural residents, benefit adjustments of medical insurance, fund expenditure
