基本医疗保险异地就医结算服务研究——以海南省跨省异地就医结算服务为例.pdfVIP

中国卫生事业管理 2015 年第3 期(总第 321 期) 基本医疗保险异地就医结算服务研究* 一一以海南省跨省异地就医结算服务为例 李芬1 ，陈燕妮2 (1.海南大学政治与公共管理学院，海南海口 570228;2. 海南省社会保险事业管理局) [摘要] 人口流动使得以户籍制度为基础的基本医疗保险制度在待遇给付时陷入"参保却不能报销"的困境，异地 就医结算服务的实施不仅有利于确保人们享受基本医保待遇不受户籍与地域限制，而且对于推进基本医疗保险全国统筹 具有重要意义。文章主要以基本医疗保险异地就医结算服务为研究对象，通过考察、分析海南省异地就医结算服务出台 的背景、制度现状及实施情况，指出，异地就医结算服务对于打破基本医疗保险的地区割裂、实现全国统筹、实现参保人群 的医保待遇具有重要意义;同时，这种异地就医结算还存在着受惠面小、程序繁琐、道德风险等问题。 [关键词] 基本医疗保险;异地就医结算;海南 [中图分类号] F 847. 6 [文献标识码] A [文章编号] 1∞4-4663(2015 )03 -197-04 Studying 00 the ofTset medical settlemeot of basic medical insurance system sampled with Hainan. / Li F，锢， et a1.!/ The Chinωe Health Service Managemeot. Abstract Floating population makes the payment be difficult in basic medical insurance system based on household registra- tion system. While 由e implementation of offset medical setÙement can not only ensure the nationwide basic medical insurance ,but also promote 也e overall national basic medical insurance system. The background and implementation of accounting of medical treatment in different places in Hainan Province we陀 surveyed. Based on which ,its significances can be concluded in bl'础king the separation of medical insurance system ,realizing national financing and achieving the people's medical benefit. Meanwhile ,there still had some problems such as limited benefit ,complex procedure and moral risk. Author' s addr四s School of Politics and Public Administration ,Hainan University ,Haikou ,P. R. China. Key word basic medical insurance; offset medical setùement; Hainan. 1 问题的提出 的问题。 我国基本医疗保险制度在经济改革的大潮中受到冲击，不 为解决这一问题，2ω 年新医改方案《医药卫生体制改革 仅农村的合作医疗名存实亡，而且随着城市体制外就业人群的