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卫计委:医保制度的筹资公平性有待进一步改进

2016-01-12 16:29:51   中国新闻网

五要统一定点管理。统一定点机构管理办法,强化定点服务协议管理,健全考评机制,实行动态准入退出。对社会办医采取一视同仁的政策。

六要统一基金管理。执行统一的基金财务制度、会计制度和基金预决算管理制度,强化内控管理、外部监督制度,推进付费总额控制,健全基金运行风险预警机制,合理控制基金结余,防范基金风险,提高使用效率。

六、如何突出理顺管理体制,为城乡居民提供一体化经办服务?

理顺管理体制,实现一体化经办服务,有利于解决不同部门管理不协调、难衔接等问题,有利于提高经办管理服务效率,增强基金的安全性和管理的规范性,避免重复建设、重复补贴,实现公共服务均等化,为参保人员提供高效便捷的经办服务。《意见》对理顺管理体制,提供城乡一体化医保经办服务提出了要求:一是整合经办机构。鼓励有条件的地区理顺管理体制,统一行政管理职能。充分利用现有经办资源,对经办机构、人员、信息系统等各类经办力量进行整合,规范经办服务流程,补足经办服务短板,提供城乡一体化经办服务。二是创新经办管理。通过完善管理运行机制、提升服务手段、改进管理办法,进一步提升管理效率和服务水平。同时,鼓励有条件的地区创新经办服务模式,在确保基金安全和有效监管的前提下,以政府购买服务的方式委托商业保险机构等社会力量参与基本医保经办服务。

七、如何突出提升服务效能,不断提高基金效率和优化医保服务?

提升服务效能,对推进制度整合、实现整合目标有重要意义,有利于提高基金使用效率和优化医保服务,实现制度的平稳可持续发展。《意见》对此提出了四方面要求:一是提高统筹层次。原则上实行市(地)级统筹,鼓励有条件的地区实行省级统筹。要根据地区经济发展水平和医疗服务水平加强基金分级管理,充分调动县级政府、经办管理机构基金管理的积极性和主动性。二是整合完善信息系统,为城乡居民医保制度运行和功能拓展提供支撑,推进信息交换与数据共享,强化信息安全与隐私保护。三是完善付费方式。系统推进按人头付费、按病种付费、按床日付费、总额预付等多种付费方式相结合的复合支付方式改革,推动形成合理的医保支付标准,引导医疗机构规范服务,推进分级诊疗制度建设,引导建立合理有序的就医秩序。四是加强医疗服务监管。完善定点医疗机构协议管理,强化对医疗服务的监控。充分利用信息化手段,推进医保智能审核和实时监控,加强医疗服务监管,规范医疗服务行为。

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