医保,想说爱你并不容易——把脉福安市医疗保险制度改革管理难点

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福安市基本医疗保险制度于2001年2月1日起正式实施,按照福安市政府的统一部署,渐进启动,稳步推进。2002年1月,机关事业单位人员参保,目前参保人群已将近2万人。总的来看,医保改革开局良好,运行基本平稳,得到了社会各界的理解和支持。但是,随着改革的进一步深入,一些深层次的问题和矛盾逐步暴露出来。难点之一:套政策相对滞后国家两次召开“三改并举”会议,强调要求各地在实施医疗保险制度的同时,必须同步进行医疗卫生体制和药品流通体制改革,从而建立起医、保、患三方互相制约的费用分担机制和医疗服务机构的竞争机制。目前的状况是,医疗保险制度改革是劳动和社会保障部门单枪匹马奋力推进。虽然福安市卫生系统为了配合基本医疗保险制度的实施,降低医药费用增长幅度,采取了一系列的改革措施,如:推行药品集中招标采购,医药分开核算、分别管理;深化医疗机构人事制度和分配制度改革,竞争上岗,减员增效,降低医疗成本等。但由于种种客观原因,降低医疗费用的成效不大。如:药品集中采购公开招标后,虽然少数药品进价降低了,但获利部分并未让给参保患者,而是留在 Fuan City, the basic medical insurance system from February 1, 2001 came into effect, in accordance with the unified deployment of the Fuan city government, gradually start, steady progress. January 2002, organs and institutions staff insured, the current insured population has nearly 20,000 people. Overall, the health insurance reform has started well and has basically run smoothly. It has been understood and supported by all sectors of society. However, with the deepening of the reform, some deep-seated problems and contradictions have gradually emerged. Difficulties: set of policies lagging behind Two countries held “three changes simultaneously” meeting, emphasizing the requirements around the implementation of the medical insurance system at the same time, we must simultaneously carry out health care system and drug circulation system reform, so as to establish a medical insurance , Suffering from the trilateral mutual restraint cost-sharing mechanism and medical service agencies competition mechanism. The current situation is that the medical insurance system reform is struggling to promote the labor and social security departments alone. Although the health system in Fuan City has taken a series of reform measures in line with the implementation of the basic medical insurance system and the reduction in the growth rate of medical expenses, such as the centralized drug bidding and purchasing, the separate accounting and separate management of pharmaceuticals, the deepening of personnel system and distribution in medical institutions System reform, competition, reduction of staff efficiency, reduce medical costs. However, due to various objective reasons, the effectiveness of reducing medical expenses is not great. Such as: centralized drug purchasing public bidding, although a few drugs lower purchase price, but the profit did not give part of the insured patients, but to stay
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