金融学院知识库

  医疗保障问题是关系到全国14亿人民的重大民生问题，也是长期以来备受关注的热点问题，随着社会经济的发展，我国医疗保障制度也在不断完善当中。2016年我国开始建立城乡居民基本医疗保险，将城镇居民基本医疗保险和新型农村合作医疗保险进行了整合，整合之后虽然从一定程度上解决了原医保体系城乡分离造成的政策不统一、待遇不均衡、基金共济能力弱等问题，但是在整合过程中也发现了一些新的问题。甘肃省作为西部欠发达地区，地区差异较大，整合后城乡居民基本医疗保险存在的问题也较多。

  本文着眼于甘肃省城乡居民基本医疗保险，主要分为五大部分，第一部分主要介绍了甘肃省城乡居民基本医疗保险的发展概况以及制度背景。第二部分对本文涉及到的相关概念和基础理论进行了简要的介绍。第三部分通过对比分析甘肃省城乡居民医疗保险整合前后发展进程及现状，发现了现阶段仍然存在的一些问题，并从制度建设、基金管理、医保服务三个方面进行了分析，发现医保整合缺少体系建设规划、筹资金额不合理、缴费档次单一、基金统筹层次偏低、基金监管水平及经办管理水平有待提高、医疗保障水平城乡差异较大等问题。第四部分选取了天津、宁夏两个城乡医保发展较早的地区与甘肃省医保发展情况从统筹层次、缴费档次、缴费标准、补贴水平、报销补偿水平、基金结余、医疗投入等方面进行了对比分析。

  通过上述分析，论文从制度建设、基金管理、医保服务三个方面为甘肃省城乡居民基本医疗保险的发展提出了相应的优化建议，期望能够促进甘肃省城乡居民基本医疗保险更好的发展。

    The medical security issue is a major livelihood issue related to the 1.4 billion people, and it is also a hot issue that has attracted much attention for a long time. With the development of social economy, our country's medical security system is also constantly improving. In 2016, China began to establish the basic medical insurance for urban and rural residents, and integrated the basic medical insurance for urban residents and the new rural cooperative medical insurance. After the integration, the inconsistency of policies and unbalanced treatment caused by the separation of urban and rural areas in the original medical insurance system have been resolved to a certain extent. The weak mutual aid ability of funds and other issues, but some new problems have also been discovered in the integration process. Gansu Province, as an underdeveloped region in the west, has large regional differences. After the integration, the basic medical insurance for urban and rural residents will also have more problems. 

    This article focuses on the basic medical insurance for urban and rural residents in Gansu Province, which is divided into five parts. The first part mainly introduces the development overview and system background of the basic medical insurance for urban and rural residents in Gansu Province. The second part briefly introduces the related concepts and theoretical basis involved in this article. The third part analyzes the development process before and after the integration of medical insurance for urban and rural residents in Gansu Province, and finds some problems that still exist at this stage, and analyzes the three aspects of system construction, fund management, and medical insurance services, and finds the lack of medical insurance integration. System construction planning, unreasonable amount of funds raised, single payment level, low level of fund co-ordination, fund supervision level and handling management level need to be improved, and regional differences in medical security level. The fourth part selects two areas with earlier development of medical insurance in Tianjin and Ningxia, and compares the development of medical insurance in Gansu Province in terms of overall planning level, payment level, payment standard, subsidy level, reimbursement compensation level, fund balance, medical investment.

      Through the above analysis, The paper from the three aspects of system construction, fund management, and medical insurance services, corresponding optimization suggestions are put forward for the development of basic medical insurance for urban and rural residents in Gansu Province, hoping to promote the better development of basic medical insurance for urban and rural residents in Gansu Province.