社区卫生服务门诊统筹政策的成效与经验

在我国城镇居民基本医疗保险筹资水平较低而基本医疗保障需求较高的现实条件下，门诊统筹是提高保障水平、扩大受益面的关键。与社区卫生服务相结合，城镇居民基本医疗保险可以利用其方便价廉、安全有效的特征，充分发挥社区卫生服务的公益性及其高效率的服务优势来保障城镇居民的基本医疗和公共卫生服务。通过典型地区的实证分析，认为门诊统筹具有提高社区卫生服务公益性，提升医保资金使用效率等政策成效。试点地区的经验也表明，依托社区卫生服务的门诊统筹政策成功的原因在于典型地区都进行了服务模式转变的形态机制建设、强化公益性的运行机制建设以及提升能力的社区卫生服务内涵建设。

The effectiveness and experiences of pooling outpatient policy in Community Health Services

The pooling outpatient service is a key to increase access and improve the overall security level under the actual condition that the low financing of Basic Medical Insurance for Urban Residents but a relative higher needs for the basic health insurance. Through pooling outpatient service at the community level, it could take advantage of convenient with relative cheaper price, and relative effectiveness for Basic Health Insurance for Urban Resident. Then, it further promotes the public welfare of community health service and in turn to secure the essential medical service and public health service to urban residents. In this paper, an empirical analysis of the typical regiones indicates that pooling outpatient at community health services have the policy effectiveness of improved public welfare, enhance the efficiency of medical insurance funds. The experience of the pilot areas also shows that pooling outpatient service is successful because the typical regiones all had the reform in service transition in the form of services mechanism, the building of operation mechanisms to strengthen public welfare and the content built to enhance the capacity of community health service.