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目的:过对吉林省医保体系的历史发展和现状进行梳理,结合吉林省的实际情况,参考其他省市试点的经验,初步设计出适合我省实际情况的医保城乡统筹的机制。方法:本研究通过文献查阅、调查法、逻辑分析、综合思维法等方法,对吉林省医疗保险体系现状进行研究。结果:设计一套医保城乡统筹的体制,实现政策制定和管理的统一,明确相关部门的分工,实现城乡居民医保报销多层次、一卡通。结论:实施城乡统筹的医保方案,可以解决省内流动人口医保关系的转移接续问题,缩短城乡差距,体现宪法人人平等的理念;可以加强对医保基金的监管和对骗保行为的打击力度;可以扩大医保基金规模,使得第三方谈判力量大大增强。
Objective: To sort out the historical development and current situation of medical insurance system in Jilin Province, and to make reference to the experience of other provinces and municipalities in light of the actual conditions in Jilin Province to preliminarily design a mechanism for overall planning of medical insurance in urban and rural areas that suits our actual conditions. Methods: In this study, the current situation of medical insurance system in Jilin Province was studied through literature review, investigation, logical analysis and comprehensive thinking. Results: To design a medical insurance system for overall planning of urban and rural areas, to achieve the unification of policy making and management, to clarify the division of labor among relevant departments and to achieve multi-level and card-based reimbursement for urban and rural residents. Conclusion: The implementation of urban and rural health insurance plan can solve the transfer and continuation of the medical and insurance relations among the floating population in the province, shorten the gap between urban and rural areas and embody the concept of equality of all people in the constitution, strengthen the supervision of medical insurance fund and crack down on the fraud prevention and treatment, Can expand the scale of medical insurance funds, making the third party negotiating power greatly enhanced.