居民医保运行优化路径思考——以陕西省榆林市为例

Reflections on the Optimization Path of Residents’ Medical Insurance—A Case Study of Yulin City in Shaanxi Province

摘要: 医疗事业发展是社会进步的关键指标，我国经历了30年左右的医保制度探索，针对广大居民初步建立了城乡居民医疗保险制度，实现了惠及十亿人口的制度公平。陕西省榆林市作为典型的能源城市，医疗服务水平发展滞缓与其经济快速增长形成鲜明对比。本文梳理了该市在医保制度运行过程中直接或者间接产生的问题，进行剖析，认为主要存在制度公平下的机会不均，医保基金固定模式的运行弊端以及制度监管过程中绩效机制有待改进等问题，需要依靠区域医疗资源整合建设，优化医疗服务方式，转变健康管理重心，需求政策支持，建立医疗服务专项补贴机制，完善审查制度与方式等途径，进一步释放居民医保的制度收益，实现短期区域健康管理和医疗服务提升与长期人力资本高质量发展有效衔接，进而为推动能源城市产业升级提供坚实的“人才红利”保障。

Abstract: The development of medical care is a key indicator of social progress. Reformation of the medical insurance system has been explored by our country in about 30 years. The medical insurance system for urban and rural residents has initially been established and realizes the institutional fairness benefiting one billion people. Yulin City of Shaanxi Province, as a typical energy city, has a sharp contrast to its rapid economic growth—the sluggish development of medical services. This paper sorts out the problems directly or indirectly generated in the operation of the medical insurance system in the city and believes that there are mainly problems such as uneven opportunities under the fairness of the system, the shortcomings of the operation of the fixed mode of the medical insurance fund, and the performance mechanism in the process of system supervision needs to be improved. It is necessary to rely on these ways including the integration and construction of regional medical resources, optimize the mode of medical services, change the focus of health management, demand policy support, establish a special subsidy mechanism for medical services, improve the review system and methods and so on. It will further release the institutional benefits of residents’ medical insurance, realize the effective connection between short-term regional health management and medical service improvement and long-term high-quality development of human capital, and then provide a solid “talent dividend” guarantee for promoting the industrial upgrading of energy cities.