城乡居民基本医疗保障制度案例研究:试点实践和主要发现

本文以浙江嘉兴和江苏常熟等10个试点县市实施的"新型农村合作医疗与城镇居民基本医疗保险制度衔接"(简称"两制"衔接)为案例,实证分析了试点地区的"两制"衔接工作进展,将"两制"衔接模式总结为部分整合型、完全融合型和合作管理型,并在此基础上提炼出试点地区实施"两制"衔接的主要发现。文章认为,"两制"衔接不仅能有效解决"失地农民"和"辖区内城乡流动人口"医保权利的转移和接续问题,而且是加快我国基本医保制度统一的"良方",另外,"两制"衔接在解决外来人口医保问题、降低医保管理成本,提高管理效率等方面有很大优势,并且由卫生部门监管医疗机构存在明显的技术优势。

A case study of urban rural basic health insurance: a trial practice and main findings

On the basis of ten pilot areas, this paper analyzes the convergence of New Rural Cooperative Medical Scheme and Basic Medical Insurance of Urban Residents, and empirically summarizes three convergence models. They are fractional integration model, full inclusion model and cooperative management model. Then, some main findings are extracted basing on experiences gained from the pilot areas. It will enhance to resolve the transfer and succession of the medical insurance of the lost land farmers and floating population. In addition, it will enhance the level of convergence and extend the coverage of medical insurance system. The selection of model should take local condition into account. The unified administration will hasten the convergence, reduce the administrative cost and improve managerial efficiency. Meanwhile, the health department has comparative advantage on technical supervision.