CAJ | 학술논문

医疗保险制度是我国社会保障制度的重要组成部分,在社会保险中,医疗保险制度是保障范围最广、保障内容最多以及运行机制最复杂的社会保险项目,我国医疗保险制度在不断发展的过程中也存在许多问题.本研究对我国县级医疗保险体系存在的风险,如费用快速增长导致出现医保基金穿底的风险、医保监管不够完善等问题,进行了深入的分析,并提出诸如改革支付方式、加强对基金、需方、政府等的监管等政策建议.以期完善我国医疗保险体系,为全国其他地区县级医院改革提供理论支持与决策参考.
의료보험제도시아국사회보장제도적중요조성부분,재사회보험중,의료보험제도시보장범위최엄、보장내용최다이급운행궤제최복잡적사회보험항목,아국의료보험제도재불단발전적과정중야존재허다문제.본연구대아국현급의료보험체계존재적풍험,여비용쾌속증장도치출현의보기금천저적풍험、의보감관불구완선등문제,진행료심입적분석,병제출제여개혁지부방식、가강대기금、수방、정부등적감관등정책건의.이기완선아국의료보험체계,위전국기타지구현급의원개혁제공이론지지여결책삼고.
Medical insurance system plays a key role in China's social security system.In the social insurance system,medical insurance features the widest coverage and the most complex in mechanism,while China' s medical insurance system itself is found with many setbacks.This paper probed into such risks found in the county-level medical insurance system as excessive cost growth causing overpayment of the medical insurance fund and poor supervision of the fund.On such basis,the authors recommended such policy changes as payment reform,and enhanced supervision over the fund,the demand side,and the government,in an effort to optimize China' s medical insurance system for theoretical and decision reference of other county-level hospitals in their reforms.