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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-indent: 2em; text-align: left;">从根本上说，整合城乡医保所面临的这些关卡，就是医保体制能否顺利统一、医保资金统筹能否打破地区屏障、医疗资源能否公平分配的问题。</p><p style="text-indent: 2em; text-align: left;">人社部日前表示，将加快推动城乡基本医保整合，努力实现年底前所有?。ㄇ?、市）出台整合方案，2017年开始建立统一的城乡居民医保制度，2017年底基本实现符合转诊规定的异地就医住院费用直接结算。</p><p style="text-indent: 2em; text-align: left;">医保体制并轨是推行社会公平正义的必然之举。目前，基本医保由职工医保、城镇居民医保、新农合构成。虽然多轨并行的体制利于用较快的速度实现全民医保全覆盖，但由于管理部门不同，就医报销目录不同，缴费基数、报销比例、目录不同，城乡之间的医疗保障水平差距很大。同一家医院同样的病症，参加城镇居民医保和新农合的待遇截然不同，由此出现了“同病不同命”的差异。为彰显制度公平，今年1月，国务院印发了《关于整合城乡居民基本医疗保险制度的意见》，要求整合两种医保制度，提出了统一覆盖范围、筹资政策、保障待遇、医保目录、定点管理和基金管理的“六统一”目标要求，并制定了相应的时间表，整合城乡医保在各地启动。</p><p style="text-indent: 2em; text-align: left;">需看到，尽管已经有了顶层设计和时间表，但整合城乡医保还有诸多现实关卡需要闯过。首先，是不同管理体制能否顺利衔接。目前，城镇医保归口人社部门管理，新农合归口卫计部门管理，整合机构、人员、信息系统，统一行政管理职能，是整合城乡医保的前提。如果管理体制整合不顺畅，服务流程不规范，就可能加大改革成本，影响参保人利益。</p><p style="text-indent: 2em; text-align: left;">其次，是资金统筹能否升级。按照国务院意见要求，整合后的医保基金原则上实行市(地)级统筹，有条件的地区实行省级统筹。但是，过去分散的医?；鸸芾硖逯埔丫纬闪酥种掷娓窬?，资金运行效率低下，存在诸多漏洞，资金统筹升级，有可能面临种种软阻力。如果资金统筹的问题解决不好，城乡医保整合就可能面临运行乏力的考验。</p><p style="text-indent: 2em; text-align: left;">第三，是体制并轨是否会增加参保人负担。城乡居民医保统一，是“就高不就低”，是要将新农合医保待遇拉高到城镇水平，这就涉及农村参保人缴费标准是否会</p><p style="text-indent: 2em; text-align: left;">抬高的问题。除非国家财政补贴向新农合参保人倾斜，否则新农合参保人有可能因为经济承受能力制约而不愿意加入，从而影响全民医保的覆盖率。这就要求，财政补贴政策必须跟随城乡医保整合有所调整，中央和地方财政因此将增加多少补贴、央地财政如何协调，应有更详尽的计划。</p><p style="text-indent: 2em; text-align: left;">第四，是异地结算能否落实到位。城乡医保资金的管理，按要求仍归地方省级或市(地)级统筹，尚不能实现全国统筹。对于异地工作生活的参保者来说，异地就诊直接结算仍面临不小障碍。2017年底基本实现符合转诊规定的异地就医住院费用直接结算的目标能否实现，参保人需要付出多少时间和精力，尚有疑问。</p><p style="text-indent: 2em; text-align: left;">从根本上说，整合城乡医保所面临的这些关卡，就是医保体制能否顺利统一、医保资金统筹能否打破地区屏障、医疗资源能否公平分配的问题。这不是整合城乡医保就能解决的问题，而是对整体医改如何推进提出的命题。</p><p style="text-indent: 2em; text-align: left;">□迩晓</p> </div> <p class="Editor">编辑：赵彦 </p> <div id="i2i2jyu4k" class="Paging"> </div> <p class="Keyword">关键词：整合城乡医保医保体制并轨</p> <h1 class="pv_title_2 mt_15"><a href="/index.shtml" target="_blank" class="more mtb_14">更多</a><span id="i2i2jyu4k" class="t" id="a3"><a href="/index.shtml"><img src="/images/xg_t1.jpg" /></a></span></h1> <div id="i2i2jyu4k" class="pa_0_5_0_10"> <ul class="Related_ul bh_150"> <li><a target="_blank" 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