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class="jiathis_button_qzone"></a> <a class="jiathis_button_tsina"></a> <a class="jiathis_button_tqq"></a> <a class="jiathis_button_weixin"></a> <a class="jiathis_button_renren"></a> <a class="jiathis jiathis_txt jtico jtico_jiathis" target="_blank"></a> </div> <script type="text/javascript" src="http://v3.jiathis.com/code_mini/jia.js?uid=1399539302485450" charset="utf-8"></script> </span><span id="i2i2jyu4k" class="fr">分享到：<img src="/images/fx.jpg" /> </span> </div> <div id="i2i2jyu4k" class="text_box"> <p align="center"> <p style="text-align:center"><a rel="sexylightbox[gp]" target="_self" style="text-decoration: none;"><img src="/upload/resources/image/2015/12/24/157925_600x600.jpg" alt="点击进入下一页" style="border-width: 0px; border-style: initial; max-width: 580px; cursor: pointer;"/></a></p><p style="text-align: center; text-indent: 2em;">漫画：朱慧卿</p><p style="text-indent: 2em; text-align: left;">随着医疗服务需求的进一步释放，医疗费用支出一路增长，医?；鹧沽υ嚼丛酱蟆?/p><p style="text-indent: 2em; text-align: left;">人社部公布的《2014年度人力资源和社会保障事业发展统计公报》显示，2014年全年城镇基本医疗保险基金总收入9687亿元，支出8134亿元，分别比上年增长17.4%和19.6%，尽管收仍然大于支，但收入增幅明显低于支出增幅。</p><p style="text-indent: 2em; text-align: left;">事实上，基金收入增长速度低于支出增长速度的倾向早已显现。2012年，城镇基本医疗保险基金总收入6939亿元，支出5544亿元，分别比上年增长25.3%和25.1%，两者基本持平。至2013年，城镇基本医疗保险基金总收入8248亿元，支出6801亿元，分别比上年增长18.9%和22.7%，收入增幅开始低于支出增幅。</p><p style="text-indent: 2em; text-align: left;">人社部社会保障研究所所长金维刚此前曾介绍说，从2013年的情况来看，全国有225个统筹地区的城镇职工医保资金出现收不抵支的情况，占全国城镇职工统筹地区的32%，其中22个统筹地区将历年累计结余全部花完。在城镇居民医保方面，2013年全国有108个统筹地区出现收不抵支的情况，医保资金已经不堪重负，而且现在各项医疗保险基金支出增长率均超过收入增长率。</p><p style="text-indent: 2em; text-align: left;">2011年，广州城镇居民基本医疗保险资金缺口已达近两亿元。据《北京日报》报道，北京市基本医疗保险基金，2014年收入682.7亿元、支出648.36亿元，结余34.34亿元，滚存结余227.06亿元。城镇职工医?；鸨匦胍惺实钡慕嵊啵侠淼慕嵊嘣率?到9个月。按6个月累计结余计算，本市基本医?；鹄奂平嵊嘀辽儆Υ锏?24.18亿元，现在还有近100亿元的缺口。而部分省份如吉林省，2013年新农合资金的使用率占全年筹资额的近100%，当期几乎没有结余。</p><p style="text-indent: 2em; text-align: left;">社科院发布的《“十三五”中国社会保障发展思路与政策建议》显示，从长远看职工医保基金潜伏着严重的支付?；?，全国多数地区的职工医?；鸾?020年前后出现基金缺口。</p><p style="text-indent: 2em; text-align: left;">《中国医疗卫生事业发展报告2014》发布的预测显示，2017年城镇职工基本医疗保险基金就将出现当期收不抵支的现象，到2024年就将出现基金累计结余亏空7353亿元的严重赤字。</p><p style="text-indent: 2em; text-align: left;">近年来，职工医保的保障待遇有了显著提高，在一定程度上增加了医保基金的支出。浙江大学公共管理学院教授何文炯接受媒体采访时指出，医保目录各地不同程度地有所扩展，定点医院和定点药店也有所增加，包括封顶线提高、报销比率提高和起付线的降低，直接提高了职工医保的保障待遇。</p><p style="text-indent: 2em; text-align: left;">有限的医保资金使用效率不高也会导致医疗费用不合理增长，医保主管部门在确定医保定点单位时存在“只选贵的、不选对的”的现象。而医保定点单位通过过度诊疗、甚至骗保等途径实现“利益最大化”等现象，在不少地方也出现过。</p><p style="text-indent: 2em; text-align: left;">人口老龄化也带来了医疗开支的快速增加，慢性病显著增多，健康及医疗保险需求日益殷切。目前，我国60岁以上人口已达2亿。2052年，老龄化峰值到来，60岁以上人口将达4.87亿，未来支付压力更大。</p><p style="text-indent: 2em; text-align: left;">支出大幅增加，但是整个资金池收入却在下降，一方面年轻人口呈现下降趋势，劳动力不足，医保基金缴纳者变少。另一方面我国劳动者个人和企业的负担已然较重，“五险一金”和个人所得税负担已经占到工资总额的30%左右，提高缴费标准似乎较为困难。</p><p style="text-indent: 2em; text-align: left;">何文炯表示，未来一个时期，一般预计经济增幅会降低，因而职工医保的筹资难度会增加，至少不会比过去更容易。</p><p style="text-indent: 2em; text-align: left;">针对目前的形势，专家建议，要在稳定职工医保待遇水平的同时，建立有效的机制，控制医疗费用不合理增长，杜绝医疗保障资源的浪费。</p><p style="text-indent: 2em; text-align: left;">自2011年下半年开始，本轮新医改便把医疗费用控制摆上了显要位置，人社部、财政部、卫生部于2012年联合发布《关于开展基本医疗保险付费总额控制的意见》，规定医保管理部门在做好医?；鹉甓仍に愕幕∩?，向当地定点医疗机构预付全年的医保费用，并按照“结余留用、超支分?！钡脑?，确定医?；鸷投ǖ阋搅苹苟越嵊嘧式鸷统Х延玫姆值０旆ā５谑缘愎讨?，有的医院为了控费而出现医?；颊弑痪艿南窒?，原先的“过度医疗”可能变为“医疗不足”。</p><p style="text-indent: 2em; text-align: left;">与此同时，有专家认为，医保个人账户已经变成了一个意义不大、但问题很多的鸡肋账户，这部分钱的使用，与市民用现金购买药品、支付医疗费用的形式并无多大不同，缺乏社会共济功能。</p><p style="text-indent: 2em; text-align: left;">这些讨论之外，社科院社会政策研究中心秘书长唐钧受访时建议，建立长期照护保险，把对老人的长期照护以及维持性的看护和护理这部分服务从医疗服务中剥离出来，由原来的医疗服务转变成社会服务。</p><p style="text-indent: 2em; text-align: left;">医疗基金收不抵支问题日趋严重，金维刚认为，应通过推进医保制度改革，并强化医疗、医药、医保“三医”联动，充分发挥医保在医药卫生体制改革中的基础性作用。重点改进和完善医保支付方式，积极探索建立科学合理的医疗服务价格形成机制、医保药品价格谈判机制，缩短临床必须的创新药纳入医保支付的评审周期，适应分级诊疗的发展需要。</p><p style="text-indent: 2em; text-align: left;">同时，促进医保部门与医疗服务机构、药品生产销售企业之间构建相互合作的伙伴关系，建立医保与医疗机构、药品提供方的协商谈判机制、监督制约机制。这是“三医”联动的关键环节，也是推进医保付费方式改革和完善药品价格机制的关键。</p><p style="text-indent: 2em; text-align: 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