The medical insurance fund increase is worth supporting Tibet risk measures are mixed throttling wor-xingbayounichunnuanhuakai

The medical insurance fund growth to recover the pregnant support hidden risks worry throttle measure data show that in recent years the national health insurance fund revenue growth is less than the increase in spending. Many experts said that this "do not receive support" gradually pushed the health insurance fund "bottom" risk. What are the risks behind the annual increase of medical insurance fund? Worry about health insurance "wear bottom" is not alarmist? According to the use of medical insurance fund, reporters in Shanghai, Wuhan, Jilin and other places to investigate. Medical insurance increase income over expenditure behind the risk in the medical insurance for urban residents, according to the annual statistical bulletin of human resources and social security ministry published annually, from 2011 to 2014, the annual urban basic medical insurance fund total revenue increased by about 29%, 25%, 19% and 17%. At the same time, the growth rate of medical insurance fund expenditure is about 25%, 25%, 22% and 20% respectively. Statistics show that there are some cities and towns medical insurance fund is facing the pressure. Have universal health care as a whole, human resources and social security department, Ministry of finance, the national health plan on 2014 the national social insurance fund accounts of the Commission last November 16th announced that consists of the basic medical insurance fund for urban residents and the new rural cooperative medical fund resident basic medical insurance fund income 447 billion 700 million yuan in 2014, growth 14%; spending 424 billion 300 million yuan, a year-on-year increase of 55 billion 500 million yuan, up 15%. The balance of payments is 23 billion 400 million yuan this year. Fund expenditure growth is greater than income increase. Some experts believe that such a phenomenon in the next few years or showing a trend of aggravation. Professor Liang Hong, vice president of China Medical Insurance Research Association, believes that the growth rate of China’s medical insurance fund expenditure is larger than that of the income increase, and it may become more and more serious. He said that China’s aging population, medical new technology and new equipments become more and more popular, and included in the Medicare payment category, urban and rural medical insurance is expanding, these factors lead to rising medical expenses, but also to many city health insurance fund twist incur losses". Reporters interviewed a number of industry insiders and experts generally believe that, from the current data and actual use of the situation, the health insurance fund "bottom" risk is gradually increasing. Professor Hu Shanlian director of the Shanghai Municipal Health Development Research Center said that in recent years, the medical expenses in China with an average annual growth rate of two digit rise, more than the average wage growth is also faster than social, Medicare payment growth, in addition to considering the normal medical demand increases, scientific and effective controlling the irrational increase of medical expenses is very urgent. Dean, Huazhong University of Science and Technology health policy and Management Institute, Tongji Medical College professor Fang Pengqian said, the health insurance fund to "open source" has been very difficult, at present, the government and enterprises to take a large proportion of medical insurance, if the economic situation is not reversed, the health insurance fund "wear bottom" risk is likely to advance. Fang Pengqian believes that by 2017, the basic medical insurance fund for urban workers will be the current "can not afford to support" phenomenon, by 2024, there is a serious deficit in the fund’s accumulated surplus deficit. "Open source" and "cutting" measures of mixed treatment of small cold to spend a thousand dollars on.

医保基金增幅收不抵支藏风险 节流措施有喜有忧   数据显示,近年全国医保基金收入增幅小于支出增幅。多位专家表示,这种“收不抵支”逐步推高了医保基金的“穿底”风险。医保基金年增幅“收不抵支”的背后,哪些风险正朝我们步步逼近?担心医保“穿底”是不是杞人忧天?针对医保基金的使用状况,记者在上海、武汉、吉林等地展开调查。   医保增幅“收不抵支”背后藏风险   在城镇居民医保方面,据人力资源和社会保障部每年公布的年度统计公报,2011年至2014年,全年城镇基本医疗保险基金总收入同比增幅约29%、25%、19%和17%。同时,医保基金支出增幅约为25%、25%、22%和20%。有统计显示,目前已有部分地方的城镇医保基金面临收不抵支压力。   就全民医保整体而言,财政部、人力资源和社会保障部、国家卫生计生委去年11月16日公布的关于2014年全国社会保险基金决算的说明显示,由城镇居民基本医疗保险基金和新型农村合作医疗基金组成的居民基本医疗保险基金,2014年收入4477亿元,增长14%;支出4243亿元,比上年增加555亿元,增长15%。本年收支结余234亿元。基金支出增幅大于收入增幅。   有专家认为,这样的现象在未来几年或呈现加重趋势。中国医疗保险研究会副会长梁鸿教授认为,我国医保基金支出增幅大于收入增幅的现象或许会越来越严重。他表示,我国人口老龄化加剧,医疗新技术、新药械越来越普及,并纳入医保支付范畴,城乡医保统筹正在扩大,这些因素导致医疗费用攀升,也让许多城市医保基金“扭盈为亏”。   记者采访多位业内人士和专家普遍认为,从目前数据和实际使用情况来看,医保基金“穿底”的风险正在逐步加剧。上海市卫生发展研究中心主任胡善联教授说,近年来,我国医药费用以年均增长两位数的幅度攀升,超过社会平均工资增幅,也快于医保缴费的增长,除考虑正常医疗需求增加外,科学有效控制医疗费用不合理增长显得十分迫切。   华中科技大学健康政策与管理研究院院长、同济医学院教授方鹏骞教授说,医保基金继续“开源”已经很困难,目前政府和企业为医疗保险承担了很大的比例,如果经济状况不扭转,医保基金“穿底”风险很可能会提前。方鹏骞认为,到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年就出现基金累计结余亏空的严重赤字。   “开源”“节流”措施有喜有忧   治小感冒要花费千元,切个“鸡眼”要2000元……近年来,媒体曝光的过度医疗案例让公众质疑医保基金并未“花在刀刃上”,一些人和机构正在鲸吞医保基金“红利”。去年,武汉部分药店医保卡违规刷卡被媒体曝光。记者调查发现,套刷、代刷并不复杂:结算时,药店用医保目录中的药名代替商品,只要总额相符就可以。   这种套取医保基金的手法被媒体曝光后,武汉市人社部门采取“零容忍”态度开展“整治风暴”,出台“史上最严”规定:一经发现直接亮“红牌”取消定点医保药店资格,两年内不得再申报。   日前,记者再次在武汉调查发现,措施升级后,药店刷医保卡购物变得非常困难。   从武汉的调查情况看,当地为严格管理医保基金而出台强硬“节流”措施取得了良好的效果。据武汉市人社部门统计,截至目前,武汉已取消400多家定点药店的医保资格,追回用医保卡刷非医保用品的不合理费用8000多万元,采取措施“节流”的效果非常明显。   据了解,除了武汉,一些地方还使用医保监控等系统,对医保资金的使用进行严格监管,避免资金滥用。但是在有些地区,由于对医保基金过度收紧“节流”,群众连正常的医保、医疗需求都得不到满足。   在吉林长春,限制患者的医保支出已成行业的“潜规则”。据了解,长春部分医院为了不超过医保资金使用限制,对收治医保患者做出限制。一些医院甚至拒收医保患者,给急需用医保卡就医的患者带来了麻烦。患者想用医保住院,唯一办法就是排队等待。   据了解,患者用医保看病,医院和医保中心之间要为限额的事反复沟通,手续繁琐。如果定额用光,超额部分医保部门无法为医院兑现,医院为了避免“损失”只能拒收医保患者。长春一家市级医院的护士透露,医院限制收治医保患者之后,有科室患者数量下降了一半左右。    医保平稳运行呼唤科学机制落地   目前,我国各地不断优化医保政策,在稳步提升保障水平的同时确保医保基金安全运行。例如,上海今年起市民无论城镇户籍还是农村户籍,都可参加城乡居民基本医保,整合城乡居民医保政策和经办管理,完善基本医保管理和经办运行机制,将进一步提高医保经办能力和效率。武汉市人社局今年出台新规,取消参保缴费时间限制,居民提交材料也有所减少,最大程度上为基金“开源”。   针对医保基金的“穿底”风险,梁鸿认为,城市医疗服务水平高价格高,而农村医保缴费偏低,给基金带来压力。他建议建立国家级的医保风险准备基金或者调节资金进行托底保障。   专家认为,要从根本上解决问题,还需医疗、医保、医药三大领域改革实现“并驾齐驱”、协同推进。方鹏骞认为,“三医联动”是医改顶层设计的核心内容,不仅能解决老百姓看病贵的问题,还协调解决医院、医药领域中存在的问题。   “‘三医联动’这个顶层设计是针对三大机构,也就是医院、医药、医保之间的良性互动。三个领域改革同步进行,医院积极性提高,服务效益提升,医药厂商盈利,医疗费用降低,最终百姓受益。”方鹏骞说。 进入【新浪财经股吧】讨论相关的主题文章: