常熟市居民基本医疗保险运行效果分析

目的分析常熟市居民基本（农村合作）医疗保险运行效果。方法采用比较分析法,分析2008～2010年常熟市居民医保报表和从2家样本医院信息系统（HIS）抽取的患者医药费用数据和医保结报数据。结果基本医疗保险运行过程中,城乡居民受益程度提高,且成功避免＂穷帮富＂现象;经办机构对医疗机构约束力度加大,费用增长得到有效控制;优化了人口年龄结构,基金运行压力得以缓解。结论统筹发展新农合与城镇居民医保有利于提高城乡居民受益公平性,今后需积极探索有效的筹资增长机制,逐步缩小与职工医保的差距;有利于增强医疗机构内部监管和自主控费意识,减小基金运行风险;参保人员年龄结构老化威胁、基金运行安全,需积极应对人口老龄化的挑战。

Effect Analysis of the Basic Medical Insurance for Urban and Rural Residents in Changshu

Objectives To analyze the effect of the basic medical insurance for urban Residents and rural cooperative medical scheme in Changshu（BMIUR and RCMS）.Methods Comparative analysis was used to analyze the annual reports of BMIUR and RCMS from 2008 to 2010 and the insured＇s medical expenses from two sample hospitals during the same period.Results That the poor help the rich got avoid while raising the average extension of benefits of each policyholder.The binding force of the insurer on medical organizations and the medical costs got in control.The age structure got optimized and the financial risks got controlled.Conclusions By the coordination of NCMS and BMIUR,it was favorable to help the urban and the rural enjoy the same basic medical insurance,to enhance the initiative of self-monitoring of medical institutions.While effective funding mechanism had to be found to narrow the gap with basic medical insurance for urban employees and active measures had to be taken to meet the challenge of the aging.