我国流动人口医疗保险异地结算报销存在的障碍与对策分析 大学论文.doc

中文摘要 自20世纪90年代以来，全国有近15%的人口处于流动状态，而且规模还在持续扩大，这部分人异地就医结算报销难的问题也越来越明显。随着现代信息技术的高速发展，通过网络平台，进一步完善医疗卫生服务体系，使居民医疗保险卡信息实现地区、县、市、省、全国一卡通，成为广大人民群众所盼望解决的突出问题。 本文以江苏省为例，分析江苏省异地就医的现状，认为异地就医存在报销手续复杂、周期长；报销比例、范围、药品目录缺乏规范；制度设计模糊；缺乏有效的监管机制；缺乏人性化服务意识；道德风险加剧等方面的问题，其原因是：城乡医疗卫生资源分布不均衡；医疗保险统筹层次较低；各地软件平台不一致，地区之间缺乏交流；异地的医疗机构不受参保地政府管理等。对此，本文提出几点建议：均衡分配医疗卫生资源；逐步提高医疗保险的统筹层次；建立全国性的医疗保险数据共享平台和交换机制；让医保卡像银行卡一样，实行医疗保险的通存通兑；制度设计更加明确, 实现医疗保险险种间的顺利衔接；加大对异地就医的监管和惩治力度。 关键词：医疗保险 异地就医 障碍分析 建议 Abstract Since the 1990 s, the 15% of the population in a nearly flow state, and in the scale, expanding this part of different people go to a doctor to submit an expense account settlement difficult problem is more and more obvious. Along with the rapid development of modern information technology, through the network platform, make people realize, health insurance card information in counties, cities and provinces, the national id, become the people the hope to solve problems. This paper takes Jiangsu Province as an example, think the different medical reimbursement procedures, presence of complex long cycle; claiming reimbursement for proportion, scope, lack of standardized design catalogue of drugs; fuzzy system; the lack of effective supervision mechanism; the lack of humanized service consciousness; moral risk of exacerbation and other aspects of the problem, its reason is: urban and rural medical and health resources distribution is not balanced; medical insurance level is relatively low; throughout the software platform is not consistent, lack of communication between the different regions; the medical institutions from the insured to the government management. To this, this paper puts forward some suggestions: balanced allocation of medical resources; gradually raising the medical insurance level; the establishment of a national health insurance data sharing platform and exchange mechanisms; let Medicare card like a bank card, implementing the medical insurance system of deposit and