长三角地区异地医保互通模式探讨

通过前往沪宁杭三地及其周边主要医保中心进行实地调研，收集医保中心负责人在医保异地互通实施过程中的意见与建议，结合所查阅相关文献，发现长三角地区目前采用统筹地区代办模式、统筹地区协议互为代办模式和异地就医结算服务平台模式三种模式进行异地医保互通，三种现行模式在运行过程中各有利弊。建议长三角地区短期内维持现有模式并以协议互为代办模式为主，远期逐步建立基金统筹管理、统筹地区统一使用、参保人直接享受就医地待遇的医保统筹新模式。

Analysis on medical insurance interoperability modes of Yangtze River Delta region

Through going to Shanghai,Nanjing,Hangzhou and their lateral major medical insurance centers to collect the opinions and recommendations from people in charge,the author combine this with the access to relevant literature for analysis.There are three modes used in Yangtze River Delta region currently,namely unilateral agency,mutual agency and service platform.The three existing modes have advantages and disadvantages respectively.It is suggested that in short term Yangtze River Delta region should maintain the existing modes and focus on mutual agency,in long tern a new mode based on the integrated management and the unified application of the fund,which allows the insured enjoy the local medical insurance directly,should be established progressively.