導語：如(ru)何(he)才能(neng)寫(xie)好一篇補(bu)充醫療(liao)保險管理辦法，這就(jiu)需要搜集整理更(geng)多的資料和(he)文(wen)獻，歡迎閱讀由(you)公務(wu)員之家整理的十篇范(fan)文(wen)，供你借鑒。

篇1

隨著國家城鎮職工基本醫療保險和居民醫療保險制度相繼建立以及人們的生活水平不斷提高，廣大職工、家屬生活質量和健康需求日益增長,基本醫療保險已無法滿足企業職工及其家屬，特別是大病人員醫療保障需求，尤其是國有大型企業，職工較多，人員復雜，迫切需要企業社會保險管理部門，在新形勢、新環境下，研究建立保障多層次、管理科學、運行高效的補充醫療保障制度，以適應國有大型企業發展，增強企業醫療保障能力，進一步減輕職工醫療費個人負擔，為企業發展提供和諧穩定環境創造條件。從2004年我公司建立補充醫療保險起，在(zai)充(chong)分研究(jiu)地方基本(ben)醫(yi)療保險(xian)制度(du)，不斷總(zong)結企業補(bu)充(chong)醫(yi)療保險(xian)的(de)(de)成(cheng)功經驗與教訓的(de)(de)情況下，對國有(you)大型企業補(bu)充(chong)醫(yi)療保險(xian)管理進行認真(zhen)的(de)(de)研究(jiu)與探索，通過(guo)多年的(de)(de)實踐(jian)與應用，取(qu)得了較好的(de)(de)效果(guo)。

二、企業建立補(bu)充醫療保險的關鍵(jian)點

一是(shi)(shi)企(qi)(qi)業(ye)(ye)(ye)補(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)險(xian)保(bao)(bao)障(zhang)(zhang)水(shui)(shui)平(ping)(ping)問(wen)題(ti)。企(qi)(qi)業(ye)(ye)(ye)建(jian)立補(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)險(xian)，確(que)(que)定(ding)保(bao)(bao)障(zhang)(zhang)水(shui)(shui)平(ping)(ping)是(shi)(shi)關(guan)鍵，必須考慮企(qi)(qi)業(ye)(ye)(ye)經(jing)濟承(cheng)受能力、各類人(ren)員醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)需求以及企(qi)(qi)業(ye)(ye)(ye)歷史(shi)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)障(zhang)(zhang)水(shui)(shui)平(ping)(ping)。二是(shi)(shi)與(yu)基(ji)本醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)險(xian)有(you)效銜接的問(wen)題(ti)。重點就(jiu)是(shi)(shi)要充(chong)(chong)分發揮基(ji)本醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)險(xian)與(yu)補(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)險(xian)各自(zi)優勢，相互補(bu)(bu)充(chong)(chong)。在(zai)保(bao)(bao)障(zhang)(zhang)原則、支付(fu)內容、票據利用(yong)、信息共享等方(fang)面實現有(you)效銜接，保(bao)(bao)證(zheng)補(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)險(xian)業(ye)(ye)(ye)務(wu)順利運行(xing)。三是(shi)(shi)企(qi)(qi)業(ye)(ye)(ye)不(bu)同群(qun)體平(ping)(ping)衡問(wen)題(ti)。重點分析企(qi)(qi)業(ye)(ye)(ye)各類人(ren)員的醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)需求，確(que)(que)定(ding)不(bu)同群(qun)體醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)障(zhang)(zhang)水(shui)(shui)平(ping)(ping)，確(que)(que)保(bao)(bao)新(xin)舊制度(du)平(ping)(ping)穩銜接和(he)過渡(du)。四是(shi)(shi)補(bu)(bu)充(chong)(chong)保(bao)(bao)險(xian)基(ji)金監管(guan)問(wen)題(ti)。保(bao)(bao)障(zhang)(zhang)基(ji)金安全，防止基(ji)金流失、浪(lang)費，是(shi)(shi)補(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)險(xian)管(guan)理(li)(li)的一項重要內容，因此在(zai)補(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)險(xian)制度(du)設計中(zhong)必須充(chong)(chong)分考慮內控管(guan)理(li)(li)。五(wu)是(shi)(shi)高效運行(xing)問(wen)題(ti)。補(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)保(bao)(bao)險(xian)涉(she)及企(qi)(qi)業(ye)(ye)(ye)人(ren)事、財務(wu)、社保(bao)(bao)等部門，涉(she)及職(zhi)工醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)待(dai)遇(yu)計算(suan)、費用(yong)報銷與(yu)結算(suan)，在(zai)管(guan)理(li)(li)方(fang)式、運行(xing)機制和(he)管(guan)理(li)(li)手段(duan)等方(fang)面要科學、便捷。

三、企業補充醫療保險(xian)管理技(ji)術

一是(shi)(shi)充分考慮各類(lei)群體需求。職工、退休(xiu)人(ren)員和(he)(he)家屬（子女）分別(bie)按照當(dang)地城鎮(zhen)職工基本(ben)醫(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)和(he)(he)城鎮(zhen)居民醫(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)制度，同步建立(li)企業(ye)(ye)補充醫(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)，保(bao)(bao)持公司新(xin)舊醫(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)制度平(ping)穩過(guo)渡。二是(shi)(shi)多層次提供醫(yi)(yi)療(liao)(liao)保(bao)(bao)障。對于基本(ben)醫(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)不予負擔的(de)(de)部(bu)分，通過(guo)門(men)診和(he)(he)住院費(fei)用(yong)分別(bie)補貼(tie)辦法，解決基本(ben)養老保(bao)(bao)險(xian)(xian)(xian)門(men)診額(e)度低、住院報銷比例不高的(de)(de)問題(ti)(ti)；通過(guo)投保(bao)(bao)商業(ye)(ye)保(bao)(bao)險(xian)(xian)(xian)，解決基本(ben)醫(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)最高支(zhi)付限額(e)以上醫(yi)(yi)療(liao)(liao)費(fei)用(yong)報銷問題(ti)(ti)以及(ji)重(zhong)大疾病(bing)(bing)人(ren)員醫(yi)(yi)療(liao)(liao)費(fei)個人(ren)負擔過(guo)重(zhong)問題(ti)(ti)。三是(shi)(shi)一般疾病(bing)(bing)與(yu)特殊(shu)疾病(bing)(bing)分開(kai)管(guan)理(li)。按照“保(bao)(bao)基本(ben)、向大病(bing)(bing)傾斜”的(de)(de)原則，對于需要門(men)診長期治(zhi)療(liao)(liao)、費(fei)用(yong)較高的(de)(de)門(men)診特殊(shu)疾病(bing)(bing)患者，通過(guo)提高門(men)診報銷額(e)度和(he)(he)比例，減輕慢性疾病(bing)(bing)患者門(men)診醫(yi)(yi)療(liao)(liao)費(fei)用(yong)個人(ren)負擔。四是(shi)(shi)應(ying)用(yong)現代信(xin)息(xi)管(guan)理(li)手(shou)段。研究開(kai)發信(xin)息(xi)管(guan)理(li)軟件，應(ying)用(yong)計算機信(xin)息(xi)技(ji)術，支(zhi)持IC卡技(ji)術應(ying)用(yong)，實現企業(ye)(ye)社保(bao)(bao)部(bu)門(men)與(yu)定點醫(yi)(yi)院、基層單(dan)位(wei)的(de)(de)數據(ju)信(xin)息(xi)共(gong)享與(yu)業(ye)(ye)務處理(li)。五是(shi)(shi)完善制度，規(gui)范工作流程。重(zhong)點在補充醫(yi)(yi)療(liao)(liao)保(bao)(bao)險(xian)(xian)(xian)的(de)(de)保(bao)(bao)費(fei)籌集、費(fei)用(yong)審核、就醫(yi)(yi)流程、費(fei)用(yong)結算以及(ji)管(guan)理(li)職能等方面建立(li)各項規(gui)章制度，統一業(ye)(ye)務流程，確保(bao)(bao)業(ye)(ye)務規(gui)范運作。

四、管(guan)理技術主要創(chuang)新點和(he)效果(guo)

篇2

一(yi)、我國企業補充醫療保險管理現狀(zhuang)

相對歐美國(guo)家，我(wo)國(guo)醫(yi)療(liao)保險(xian)(xian)業(ye)(ye)起(qi)步較(jiao)晚，各企業(ye)(ye)不斷探索找(zhao)尋適合(he)自(zi)己的補充(chong)醫(yi)療(liao)模式(shi)，主(zhu)要(yao)綜合(he)考慮企業(ye)(ye)資(zi)金情況(kuang)、人(ren)員數量、年齡結(jie)構等實(shi)際情況(kuang)。目前主(zhu)要(yao)存在自(zi)主(zhu)管(guan)理(li)(li)(li)模式(shi)、商業(ye)(ye)保險(xian)(xian)公司模式(shi)、地(di)方政(zheng)府主(zhu)導模式(shi)和第(di)三方委托管(guan)理(li)(li)(li)模式(shi)四種(zhong)。大(da)型(xing)國(guo)有企業(ye)(ye)大(da)多實(shi)行企業(ye)(ye)自(zi)主(zhu)管(guan)理(li)(li)(li)模式(shi)，或(huo)是選擇(ze)第(di)三方管(guan)理(li)(li)(li)模式(shi)，在提高(gao)職工(gong)醫(yi)療(liao)待遇、享受(shou)專業(ye)(ye)化醫(yi)療(liao)服務的同時提升企業(ye)(ye)醫(yi)療(liao)管(guan)理(li)(li)(li)水平(ping)。企業(ye)(ye)人(ren)員結(jie)構年輕、人(ren)員數量少、醫(yi)療(liao)費用少或(huo)管(guan)理(li)(li)(li)機構簡單的企業(ye)(ye)，大(da)多參(can)加地(di)方補充(chong)醫(yi)療(liao)保險(xian)(xian)或(huo)選擇(ze)商業(ye)(ye)醫(yi)療(liao)保險(xian)(xian)，從而(er)有效(xiao)控(kong)制企業(ye)(ye)整體(ti)醫(yi)療(liao)成(cheng)本。

二(er)、大型國有企業補充醫療管(guan)理現狀

目前大型國有企(qi)(qi)(qi)業(ye)補充醫(yi)療保險統(tong)(tong)(tong)(tong)(tong)(tong)籌(chou)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)模式(shi)大致分(fen)(fen)(fen)(fen)為(wei)(wei)“省(sheng)(sheng)級公司(si)統(tong)(tong)(tong)(tong)(tong)(tong)籌(chou)”、“省(sheng)(sheng)級公司(si)部(bu)(bu)分(fen)(fen)(fen)(fen)統(tong)(tong)(tong)(tong)(tong)(tong)籌(chou)”兩種(zhong)。“省(sheng)(sheng)級公司(si)統(tong)(tong)(tong)(tong)(tong)(tong)籌(chou)”的(de)特(te)點(dian)(dian)為(wei)(wei)統(tong)(tong)(tong)(tong)(tong)(tong)一(yi)(yi)(yi)(yi)基金運(yun)(yun)(yun)(yun)行(xing)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)，統(tong)(tong)(tong)(tong)(tong)(tong)一(yi)(yi)(yi)(yi)委(wei)(wei)托或經(jing)辦業(ye)務，優(you)點(dian)(dian)為(wei)(wei)統(tong)(tong)(tong)(tong)(tong)(tong)一(yi)(yi)(yi)(yi)征繳、支付能力強、資(zi)金安全。“省(sheng)(sheng)級公司(si)部(bu)(bu)分(fen)(fen)(fen)(fen)統(tong)(tong)(tong)(tong)(tong)(tong)籌(chou)”的(de)特(te)點(dian)(dian)為(wei)(wei)政策(ce)相對統(tong)(tong)(tong)(tong)(tong)(tong)一(yi)(yi)(yi)(yi)、業(ye)務企(qi)(qi)(qi)業(ye)自(zi)(zi)行(xing)經(jing)辦，優(you)點(dian)(dian)為(wei)(wei)基層單位靈活度較大，資(zi)金安全性高，有利于總體費用控(kong)制(zhi)。在“省(sheng)(sheng)級公司(si)統(tong)(tong)(tong)(tong)(tong)(tong)籌(chou)”和“省(sheng)(sheng)級公司(si)部(bu)(bu)分(fen)(fen)(fen)(fen)統(tong)(tong)(tong)(tong)(tong)(tong)籌(chou)”兩種(zhong)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)模式(shi)下(xia)，又分(fen)(fen)(fen)(fen)為(wei)(wei)“自(zi)(zi)主(zhu)運(yun)(yun)(yun)(yun)作”、“第(di)三(san)(san)方(fang)委(wei)(wei)托”、“自(zi)(zi)主(zhu)運(yun)(yun)(yun)(yun)作與第(di)三(san)(san)方(fang)委(wei)(wei)托混合(he)”三(san)(san)種(zhong)運(yun)(yun)(yun)(yun)作方(fang)式(shi)。“自(zi)(zi)主(zhu)運(yun)(yun)(yun)(yun)作”是(shi)指(zhi)企(qi)(qi)(qi)業(ye)醫(yi)保管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)部(bu)(bu)門設專戶管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)，單獨管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)，優(you)點(dian)(dian)為(wei)(wei)自(zi)(zi)主(zhu)性較強，簡便(bian)易行(xing)，管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)費用低(di)。“第(di)三(san)(san)方(fang)委(wei)(wei)托”是(shi)指(zhi)由企(qi)(qi)(qi)業(ye)制(zhi)定補充醫(yi)療保險管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)辦法，將補充醫(yi)療保險事務交由第(di)三(san)(san)方(fang)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)機(ji)構(gou)統(tong)(tong)(tong)(tong)(tong)(tong)一(yi)(yi)(yi)(yi)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)，優(you)點(dian)(dian)為(wei)(wei)降低(di)企(qi)(qi)(qi)業(ye)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)人力成本，轉移企(qi)(qi)(qi)業(ye)運(yun)(yun)(yun)(yun)作風險，提高運(yun)(yun)(yun)(yun)作效率。“自(zi)(zi)主(zhu)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)和第(di)三(san)(san)方(fang)委(wei)(wei)托混合(he)”是(shi)指(zhi)企(qi)(qi)(qi)業(ye)和第(di)三(san)(san)方(fang)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)機(ji)構(gou)共同管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)補充醫(yi)療資(zi)金，企(qi)(qi)(qi)業(ye)自(zi)(zi)留一(yi)(yi)(yi)(yi)部(bu)(bu)分(fen)(fen)(fen)(fen)資(zi)金，用于醫(yi)療費用支出，其余基金委(wei)(wei)托第(di)三(san)(san)方(fang)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)機(ji)構(gou)管(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)運(yun)(yun)(yun)(yun)作，優(you)點(dian)(dian)為(wei)(wei)緩(huan)解企(qi)(qi)(qi)業(ye)部(bu)(bu)分(fen)(fen)(fen)(fen)壓(ya)力，保留部(bu)(bu)分(fen)(fen)(fen)(fen)自(zi)(zi)主(zhu)性，有利于醫(yi)療費用合(he)理(li)(li)(li)(li)(li)(li)支出。

三、典型管理(li)及(ji)運作模式(shi)研究(jiu)

為進一(yi)(yi)(yi)步提高企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)水平，進一(yi)(yi)(yi)步規(gui)(gui)范(fan)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)工作(zuo)，加(jia)強(qiang)(qiang)(qiang)和改進企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)控(kong)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)顯得尤為重要(yao)。結(jie)合內(nei)外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)研究，按照“運(yun)(yun)(yun)(yun)作(zuo)規(gui)(gui)范(fan)、管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)控(kong)到位(wei)(wei)(wei)(wei)”的(de)(de)(de)(de)(de)(de)(de)(de)原則，設計出六種“典(dian)(dian)型管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)+運(yun)(yun)(yun)(yun)作(zuo)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)”。管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)一(yi)(yi)(yi)：省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)全(quan)(quan)(quan)(quan)統(tong)(tong)(tong)籌+自(zi)(zi)主(zhu)(zhu)運(yun)(yun)(yun)(yun)作(zuo)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)層(ceng)面(mian)統(tong)(tong)(tong)一(yi)(yi)(yi)制定(ding)(ding)(ding)(ding)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)政(zheng)策(ce)，由(you)(you)(you)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)自(zi)(zi)主(zhu)(zhu)運(yun)(yun)(yun)(yun)作(zuo)、完(wan)全(quan)(quan)(quan)(quan)封閉運(yun)(yun)(yun)(yun)行(xing)(xing)的(de)(de)(de)(de)(de)(de)(de)(de)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)適(shi)用(yong)(yong)(yong)于(yu)已(yi)(yi)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)擬(ni)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)全(quan)(quan)(quan)(quan)統(tong)(tong)(tong)籌管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)，省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)能(neng)(neng)(neng)力(li)(li)達到要(yao)求(qiu)(qiu)，并已(yi)(yi)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)有條件省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)統(tong)(tong)(tong)一(yi)(yi)(yi)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)信(xin)息化(hua)平臺的(de)(de)(de)(de)(de)(de)(de)(de)單(dan)(dan)位(wei)(wei)(wei)(wei)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)能(neng)(neng)(neng)在省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)范(fan)圍(wei)內(nei)統(tong)(tong)(tong)籌平衡使用(yong)(yong)(yong)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)基金，充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)分(fen)(fen)(fen)(fen)提高基金的(de)(de)(de)(de)(de)(de)(de)(de)利(li)用(yong)(yong)(yong)率(lv)，充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)分(fen)(fen)(fen)(fen)發(fa)(fa)揮(hui)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)統(tong)(tong)(tong)籌抗(kang)風險(xian)(xian)、調劑和支付能(neng)(neng)(neng)力(li)(li)強(qiang)(qiang)(qiang)的(de)(de)(de)(de)(de)(de)(de)(de)優點(dian)。管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)二(er)(er)：省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)全(quan)(quan)(quan)(quan)統(tong)(tong)(tong)籌+全(quan)(quan)(quan)(quan)委(wei)(wei)托(tuo)(tuo)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)層(ceng)面(mian)統(tong)(tong)(tong)一(yi)(yi)(yi)制定(ding)(ding)(ding)(ding)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)政(zheng)策(ce)，通過(guo)法(fa)定(ding)(ding)(ding)(ding)合理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)的(de)(de)(de)(de)(de)(de)(de)(de)程序，對符(fu)合資(zi)質的(de)(de)(de)(de)(de)(de)(de)(de)外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)進行(xing)(xing)篩選(xuan)，委(wei)(wei)托(tuo)(tuo)一(yi)(yi)(yi)家或(huo)(huo)(huo)(huo)(huo)(huo)(huo)幾(ji)家外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)具(ju)體負責企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)的(de)(de)(de)(de)(de)(de)(de)(de)全(quan)(quan)(quan)(quan)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)，并由(you)(you)(you)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)進行(xing)(xing)監督(du)(du)檢(jian)(jian)查(cha)考(kao)核(he)(he)等的(de)(de)(de)(de)(de)(de)(de)(de)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)適(shi)用(yong)(yong)(yong)于(yu)已(yi)(yi)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)擬(ni)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)全(quan)(quan)(quan)(quan)統(tong)(tong)(tong)籌管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)，省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)不(bu)具(ju)備(bei)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)能(neng)(neng)(neng)力(li)(li)，省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)內(nei)外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)能(neng)(neng)(neng)夠(gou)提供符(fu)合要(yao)求(qiu)(qiu)服務(wu)(wu)(wu)(wu)(wu)的(de)(de)(de)(de)(de)(de)(de)(de)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)可以充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)分(fen)(fen)(fen)(fen)發(fa)(fa)揮(hui)外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)的(de)(de)(de)(de)(de)(de)(de)(de)專業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)化(hua)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)和運(yun)(yun)(yun)(yun)作(zuo)，轉移(yi)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)運(yun)(yun)(yun)(yun)作(zuo)風險(xian)(xian)，提高運(yun)(yun)(yun)(yun)作(zuo)效率(lv)，降低(di)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)人力(li)(li)成本。管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)三：省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)全(quan)(quan)(quan)(quan)統(tong)(tong)(tong)籌+（自(zi)(zi)主(zhu)(zhu)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)+部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)委(wei)(wei)托(tuo)(tuo)）管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)層(ceng)面(mian)統(tong)(tong)(tong)一(yi)(yi)(yi)制定(ding)(ding)(ding)(ding)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)政(zheng)策(ce)，由(you)(you)(you)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)來自(zi)(zi)主(zhu)(zhu)運(yun)(yun)(yun)(yun)作(zuo)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)，同(tong)時參(can)照管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)二(er)(er)，委(wei)(wei)托(tuo)(tuo)一(yi)(yi)(yi)家或(huo)(huo)(huo)(huo)(huo)(huo)(huo)幾(ji)家外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)負責部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)，并由(you)(you)(you)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)進行(xing)(xing)監督(du)(du)檢(jian)(jian)查(cha)考(kao)核(he)(he)等的(de)(de)(de)(de)(de)(de)(de)(de)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)適(shi)用(yong)(yong)(yong)于(yu)已(yi)(yi)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)擬(ni)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)全(quan)(quan)(quan)(quan)統(tong)(tong)(tong)籌管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)，省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)能(neng)(neng)(neng)力(li)(li)有所欠缺，省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)內(nei)外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)能(neng)(neng)(neng)夠(gou)提供符(fu)合要(yao)求(qiu)(qiu)服務(wu)(wu)(wu)(wu)(wu)的(de)(de)(de)(de)(de)(de)(de)(de)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)除了具(ju)有上(shang)(shang)述管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)一(yi)(yi)(yi)、二(er)(er)的(de)(de)(de)(de)(de)(de)(de)(de)各方面(mian)特點(dian)外(wai)(wai)，還具(ju)有相當(dang)的(de)(de)(de)(de)(de)(de)(de)(de)靈活(huo)(huo)性(xing)，可根(gen)據省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)內(nei)外(wai)(wai)各方面(mian)情況，靈活(huo)(huo)調整(zheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)與外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)的(de)(de)(de)(de)(de)(de)(de)(de)具(ju)體業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)范(fan)圍(wei)。管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)四：省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)統(tong)(tong)(tong)籌+自(zi)(zi)主(zhu)(zhu)運(yun)(yun)(yun)(yun)作(zuo)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)將(jiang)制定(ding)(ding)(ding)(ding)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)政(zheng)策(ce)的(de)(de)(de)(de)(de)(de)(de)(de)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)權限(xian)下(xia)(xia)放(fang)(fang)至(zhi)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)，省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)負責部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)者不(bu)負責具(ju)體業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)，市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)負責全(quan)(quan)(quan)(quan)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)者部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)，自(zi)(zi)主(zhu)(zhu)運(yun)(yun)(yun)(yun)作(zuo)，完(wan)全(quan)(quan)(quan)(quan)封閉運(yun)(yun)(yun)(yun)行(xing)(xing)的(de)(de)(de)(de)(de)(de)(de)(de)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)適(shi)用(yong)(yong)(yong)于(yu)已(yi)(yi)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)擬(ni)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)統(tong)(tong)(tong)籌管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)，省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)能(neng)(neng)(neng)力(li)(li)達到要(yao)求(qiu)(qiu)，組織(zhi)體系健全(quan)(quan)(quan)(quan)，人員配置完(wan)備(bei)的(de)(de)(de)(de)(de)(de)(de)(de)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)能(neng)(neng)(neng)有效提高企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)基金的(de)(de)(de)(de)(de)(de)(de)(de)運(yun)(yun)(yun)(yun)作(zuo)效率(lv)，減(jian)輕省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)的(de)(de)(de)(de)(de)(de)(de)(de)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)壓力(li)(li)，同(tong)時充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)分(fen)(fen)(fen)(fen)發(fa)(fa)揮(hui)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)的(de)(de)(de)(de)(de)(de)(de)(de)主(zhu)(zhu)觀能(neng)(neng)(neng)動性(xing)，對于(yu)某些具(ju)有屬地(di)特征的(de)(de)(de)(de)(de)(de)(de)(de)項(xiang)目及病種具(ju)有更有效用(yong)(yong)(yong)。管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)五(wu)：省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)統(tong)(tong)(tong)籌+全(quan)(quan)(quan)(quan)委(wei)(wei)托(tuo)(tuo)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)將(jiang)制定(ding)(ding)(ding)(ding)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)政(zheng)策(ce)的(de)(de)(de)(de)(de)(de)(de)(de)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)權限(xian)下(xia)(xia)放(fang)(fang)至(zhi)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)，由(you)(you)(you)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)通過(guo)法(fa)定(ding)(ding)(ding)(ding)合理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)的(de)(de)(de)(de)(de)(de)(de)(de)程序，對符(fu)合資(zi)質的(de)(de)(de)(de)(de)(de)(de)(de)外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)進行(xing)(xing)篩選(xuan)，委(wei)(wei)托(tuo)(tuo)一(yi)(yi)(yi)家或(huo)(huo)(huo)(huo)(huo)(huo)(huo)幾(ji)家外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)具(ju)體負責企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)的(de)(de)(de)(de)(de)(de)(de)(de)全(quan)(quan)(quan)(quan)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)，并由(you)(you)(you)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)進行(xing)(xing)監督(du)(du)檢(jian)(jian)查(cha)考(kao)核(he)(he)等的(de)(de)(de)(de)(de)(de)(de)(de)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)適(shi)用(yong)(yong)(yong)于(yu)已(yi)(yi)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)擬(ni)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)統(tong)(tong)(tong)籌管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)，省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)不(bu)具(ju)備(bei)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)能(neng)(neng)(neng)力(li)(li)的(de)(de)(de)(de)(de)(de)(de)(de)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)以及省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)有全(quan)(quan)(quan)(quan)委(wei)(wei)托(tuo)(tuo)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)要(yao)求(qiu)(qiu)的(de)(de)(de)(de)(de)(de)(de)(de)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)結(jie)合了管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)二(er)(er)與管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)四的(de)(de)(de)(de)(de)(de)(de)(de)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)特點(dian)，既充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)分(fen)(fen)(fen)(fen)考(kao)慮了市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)的(de)(de)(de)(de)(de)(de)(de)(de)主(zhu)(zhu)觀能(neng)(neng)(neng)動性(xing)和積極性(xing)，也充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)分(fen)(fen)(fen)(fen)發(fa)(fa)揮(hui)外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)的(de)(de)(de)(de)(de)(de)(de)(de)專業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)化(hua)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)和運(yun)(yun)(yun)(yun)作(zuo)能(neng)(neng)(neng)力(li)(li)，合法(fa)合規(gui)(gui)地(di)在企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)各方面(mian)為職(zhi)工提供更廣泛、更優質的(de)(de)(de)(de)(de)(de)(de)(de)服務(wu)(wu)(wu)(wu)(wu)。管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)六：省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)統(tong)(tong)(tong)籌+（自(zi)(zi)主(zhu)(zhu)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)+部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)委(wei)(wei)托(tuo)(tuo)）管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)將(jiang)制定(ding)(ding)(ding)(ding)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)政(zheng)策(ce)的(de)(de)(de)(de)(de)(de)(de)(de)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)權限(xian)下(xia)(xia)放(fang)(fang)至(zhi)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)，由(you)(you)(you)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)來自(zi)(zi)主(zhu)(zhu)運(yun)(yun)(yun)(yun)作(zuo)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)，同(tong)時參(can)照管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)五(wu)，委(wei)(wei)托(tuo)(tuo)一(yi)(yi)(yi)家或(huo)(huo)(huo)(huo)(huo)(huo)(huo)幾(ji)家外(wai)(wai)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)負責部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)(xian)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)，并由(you)(you)(you)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)進行(xing)(xing)監督(du)(du)檢(jian)(jian)查(cha)考(kao)核(he)(he)等的(de)(de)(de)(de)(de)(de)(de)(de)企(qi)(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)(bu)充(chong)(chong)(chong)(chong)(chong)(chong)(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)(liao)(liao)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)。該(gai)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)適(shi)用(yong)(yong)(yong)于(yu)已(yi)(yi)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)擬(ni)建(jian)(jian)(jian)(jian)(jian)立(li)(li)(li)(li)省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)級(ji)(ji)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)統(tong)(tong)(tong)籌管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)，省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)內(nei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)具(ju)備(bei)部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)(ye)務(wu)(wu)(wu)(wu)(wu)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)辦(ban)(ban)(ban)(ban)能(neng)(neng)(neng)力(li)(li)的(de)(de)(de)(de)(de)(de)(de)(de)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)以及省(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)(sheng)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)市(shi)(shi)、縣(xian)(xian)(xian)(xian)(xian)參(can)保(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)(wei)(wei)(wei)有部(bu)(bu)(bu)(bu)(bu)(bu)(bu)分(fen)(fen)(fen)(fen)委(wei)(wei)托(tuo)(tuo)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)要(yao)求(qiu)(qiu)的(de)(de)(de)(de)(de)(de)(de)(de)公(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)司(si)(si)(si)(si)(si)(si)(si)(si)。此種典(dian)(dian)型管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)(de)特點(dian)與管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)五(wu)相類似，但具(ju)有最強(qiang)(qiang)(qiang)的(de)(de)(de)(de)(de)(de)(de)(de)靈活(huo)(huo)性(xing)和適(shi)用(yong)(yong)(yong)性(xing)，需(xu)支付一(yi)(yi)(yi)定(ding)(ding)(ding)(ding)管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)費，能(neng)(neng)(neng)夠(gou)適(shi)用(yong)(yong)(yong)于(yu)任何未(wei)采(cai)用(yong)(yong)(yong)以上(shang)(shang)五(wu)種管(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模(mo)(mo)(mo)(mo)(mo)(mo)(mo)式(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)(de)單(dan)(dan)位(wei)(wei)(wei)(wei)。

篇3

――2004年，揚(yang)中市(shi)在江蘇省委、省政府提出(chu)了(le)為(wei)農村辦(ban)(ban)好“五件實(shi)事”之(zhi)一的推行農村合(he)作醫(yi)(yi)療(liao)(liao)保險的工(gong)作要求下，廣泛聽取(qu)社會各界意見，出(chu)臺了(le)《揚(yang)中市(shi)新(xin)型農村合(he)作醫(yi)(yi)療(liao)(liao)制度管理(li)辦(ban)(ban)法及其補充(chong)規定》，將全市(shi)農村居(ju)民(min)、學生、外(wai)來務工(gong)農民(min)等統一納入到新(xin)型農村合(he)作醫(yi)(yi)療(liao)(liao)的范疇。

――2007年，揚(yang)(yang)中市出臺了《揚(yang)(yang)中市城鎮居(ju)民基(ji)本醫療(liao)保(bao)(bao)險管理辦法》，將(jiang)未參(can)加職工基(ji)本醫療(liao)保(bao)(bao)險、住院醫療(liao)保(bao)(bao)險、新農合的城鎮居(ju)民納入(ru)醫保(bao)(bao)范疇。

――2009年，揚中市通過統一政策制度，統一保障待遇，率先將新農合與城保進(jin)行了無縫對(dui)接，并軌運行，打破了城鄉二(er)元分割的保障模式，讓廣大(da)城鄉居民都享受到了同等(deng)醫保待遇。這一創(chuang)新舉措(cuo)在(zai)當時完全(quan)走(zou)在(zai)了全(quan)省乃至(zhi)全(quan)國的前列。

――2012年，揚中(zhong)市又將(jiang)新生(sheng)兒(er)納入(ru)居民(min)醫保(bao)的(de)參保(bao)范圍，在家長自愿的(de)原則下，打破參保(bao)時間限制，采取“即生(sheng)即保(bao)即享受待遇”，讓新生(sheng)兒(er)自出生(sheng)之日(ri)起即能(neng)享受到醫保(bao)待遇。

到(dao)2015年，我市參(can)保(bao)居民為(wei)175625人，其(qi)中居民參(can)保(bao)142078人，學生參(can)保(bao)33547人，在校大(da)學生全部納入了(le)居民醫療(liao)保(bao)險，參(can)保(bao)率(lv)達(da)99.6%，基本實(shi)現了(le)全民參(can)保(bao)。

從破(po)冰(bing)試水(shui)到穩步推進，我(wo)市(shi)居民保險(xian)工作走(zou)過10余(yu)年歷程，已然(ran)成(cheng)為全民醫療(liao)保障體系的(de)一個重要組(zu)成(cheng)部分(fen)。

一(yi)、加大財政(zheng)投入，提高(gao)醫(yi)保待遇

提高(gao)(gao)醫保待遇，加(jia)大財政(zheng)投入歷(li)來是揚中市(shi)委(wei)、市(shi)政(zheng)府調整政(zheng)策的(de)主(zhu)線，揚中市(shi)每年都會根據基金的(de)運(yun)營情(qing)況及疾(ji)病譜(pu)的(de)變化，增加(jia)財政(zheng)投入，適當(dang)提高(gao)(gao)報銷待遇。

2004年(nian)(nian)我(wo)市財(cai)政(zheng)(zheng)投入179.61萬元(yuan)(yuan)(yuan)，2015年(nian)(nian)揚中財(cai)政(zheng)(zheng)補助(zhu)達到5934.23萬元(yuan)(yuan)(yuan)。十年(nian)(nian)間，財(cai)政(zheng)(zheng)強(qiang)有力的投入是我(wo)市居(ju)民醫(yi)保(bao)持(chi)續發(fa)展的不(bu)懈(xie)動力。2004年(nian)(nian)，我(wo)市新(xin)農合個(ge)(ge)人繳費(fei)50元(yuan)(yuan)(yuan)，財(cai)政(zheng)(zheng)補助(zhu)只有每人20元(yuan)(yuan)(yuan)。2015我(wo)市居(ju)民醫(yi)保(bao)個(ge)(ge)人繳費(fei)200元(yuan)(yuan)(yuan)，財(cai)政(zheng)(zheng)補助(zhu)已達到了430元(yuan)(yuan)(yuan)。

在(zai)提(ti)(ti)高報銷(xiao)(xiao)待遇方面，“一(yi)(yi)(yi)降一(yi)(yi)(yi)升一(yi)(yi)(yi)并(bing)”是對十年來揚中市(shi)醫保政(zheng)策發展歷程(cheng)的(de)最(zui)好概括(kuo)：“一(yi)(yi)(yi)降”指我市(shi)住院報銷(xiao)(xiao)起付線由1000元(yuan)(yuan)(yuan)(yuan)降至500元(yuan)(yuan)(yuan)(yuan)（社區醫療機構(gou)300元(yuan)(yuan)(yuan)(yuan)，揚中以(yi)外醫療機構(gou)1000元(yuan)(yuan)(yuan)(yuan)）；“一(yi)(yi)(yi)升”指報銷(xiao)(xiao)最(zui)低(di)檔封頂線由2萬(wan)(wan)元(yuan)(yuan)(yuan)(yuan)提(ti)(ti)高到8萬(wan)(wan)元(yuan)(yuan)(yuan)(yuan)，最(zui)高檔封頂線由3萬(wan)(wan)元(yuan)(yuan)(yuan)(yuan)提(ti)(ti)高到12萬(wan)(wan)元(yuan)(yuan)(yuan)(yuan)；“一(yi)(yi)(yi)并(bing)”指合并(bing)低(di)費用段報銷(xiao)(xiao)比例，將原來的(de)“0-3000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)30%、3001-5000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)40%、5001-10000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)45%、10001-15000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)50%、15001-20000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)55%、20001-25000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)60%、25001-30000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)65%”整合并(bing)軌(gui)為“0-10000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)60%、10001-50000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)65%、50001-120000元(yuan)(yuan)(yuan)(yuan)補(bu)(bu)(bu)償(chang)(chang)(chang)70%”。

不(bu)僅(jin)如此，揚中(zhong)市醫(yi)(yi)保(bao)(bao)中(zhong)心(xin)還(huan)不(bu)斷擴大(da)補償范(fan)(fan)圍(wei)，實行一(yi)系列減(jian)負措(cuo)施。2007年(nian)(nian)，在(zai)堅持住(zhu)(zhu)院(yuan)(yuan)補償為主的前提下，將(jiang)小額門診(zhen)醫(yi)(yi)療(liao)費(fei)用(yong)納(na)入補償范(fan)(fan)圍(wei)；2008年(nian)(nian)，將(jiang)病床(chuang)費(fei)結(jie)算(suan)標(biao)準由每(mei)天(tian)17元提高(gao)至30元，提高(gao)藥品報(bao)銷(xiao)(xiao)比例(li)；2009年(nian)(nian)，將(jiang) 17種慢性病門診(zhen)治療(liao)費(fei)用(yong)視作住(zhu)(zhu)院(yuan)(yuan)予以報(bao)銷(xiao)(xiao)；2010年(nian)(nian)將(jiang)參保(bao)(bao)人(ren)員住(zhu)(zhu)院(yuan)(yuan)期間發生的特(te)殊檢查費(fei)用(yong)納(na)入可結(jie)算(suan)醫(yi)(yi)療(liao)費(fei)用(yong)范(fan)(fan)圍(wei)；2011年(nian)(nian)將(jiang)患白血(xue)病、先天(tian)性心(xin)臟病參保(bao)(bao)學生納(na)入醫(yi)(yi)療(liao)救助(zhu)范(fan)(fan)圍(wei)； 2012年(nian)(nian)將(jiang)孕(yun)產婦住(zhu)(zhu)院(yuan)(yuan)分(fen)娩納(na)入報(bao)銷(xiao)(xiao)范(fan)(fan)圍(wei)； 2013年(nian)(nian)我(wo)市居(ju)民醫(yi)(yi)療(liao)保(bao)(bao)障待遇又有了“大(da)手筆”：一(yi)方面(mian)是提高(gao)居(ju)民醫(yi)(yi)保(bao)(bao)年(nian)(nian)度(du)可結(jie)算(suan)費(fei)用(yong)封(feng)頂線，另一(yi)方面(mian)是提高(gao)居(ju)民醫(yi)(yi)保(bao)(bao)鄉(xiang)鎮衛生院(yuan)(yuan)住(zhu)(zhu)院(yuan)(yuan)報(bao)銷(xiao)(xiao)比例(li)。按照“基層首診(zhen)，逐(zhu)級轉(zhuan)診(zhen)，建立分(fen)級醫(yi)(yi)療(liao)制(zhi)度(du)”的要求，將(jiang)在(zai)我(wo)市鄉(xiang)鎮衛生院(yuan)(yuan)（含社(she)區(qu)衛生服務中(zhong)心(xin)）住(zhu)(zhu)院(yuan)(yuan)治療(liao)的居(ju)民醫(yi)(yi)保(bao)(bao)參保(bao)(bao)人(ren)員起付線以上(shang)的醫(yi)(yi)療(liao)費(fei)用(yong)由原來(lai)補償70--80%提高(gao)到85%，比在(zai)市級醫(yi)(yi)院(yuan)(yuan)就醫(yi)(yi)平均多(duo)補償20多(duo)個(ge)百分(fen)點。

2014、15年我(wo)市居民(min)保險(xian)政策(ce)大(da)體上保持(chi)了(le)穩定(ding)，增設了(le)特(te)殊藥品的報(bao)銷政策(ce)，將(jiang)用(yong)于治(zhi)療(liao)慢性髓性白血病(bing)(bing)(bing)的格列(lie)衛、達希納、伊馬(ma)替(ti)尼，治(zhi)療(liao)胃腸間(jian)質瘤的格列(lie)衛，治(zhi)療(liao)腫瘤的赫(he)賽汀納入居民(min)醫療(liao)保險(xian)報(bao)銷75%。并實(shi)施(shi)了(le)居民(min)大(da)病(bing)(bing)(bing)保險(xian)，這兩項政策(ce)的實(shi)施(shi)，切(qie)實(shi)減輕了(le)參保人員(yuan)大(da)病(bing)(bing)(bing)醫療(liao)費用(yong)的負擔，有效(xiao)緩解大(da)病(bing)(bing)(bing)患者因病(bing)(bing)(bing)致貧、因病(bing)(bing)(bing)返貧的問(wen)題。

二、多(duo)渠(qu)道擴大(da)參保面

在揚(yang)中(zhong)市，在校學(xue)生(sheng)、在園幼兒能不能參加醫(yi)療保險(xian)，一直(zhi)是(shi)家長們普遍關心的問題。2004年8月，揚(yang)中(zhong)市出臺《揚(yang)中(zhong)市新型農村合作醫(yi)療保險(xian)管理(li)辦法(fa)補充規定》，將學(xue)生(sheng)兒童納入了保障范圍(wei)。

從(cong)2004年(nian)至2015年(nian)，我市四次提(ti)高(gao)學(xue)生醫保的(de)個人繳費(fei)標(biao)準，財政補助(zhu)也一漲再漲，從(cong)最初(chu)每人每年(nian)籌資標(biao)準65元，其中個人繳費(fei)45元，政府(fu)補助(zhu)20元，提(ti)高(gao)到(dao)現在的(de)每人每年(nian)籌資標(biao)準630元，其中個人繳費(fei)200元，政府(fu)補助(zhu)430元。

在校(xiao)學(xue)生(sheng)、在園幼兒每年度符合規定(ding)的可結算(suan)醫(yi)(yi)療費(fei)用(yong)最高(gao)限額(e)為(wei)12萬元，門診醫(yi)(yi)療費(fei)用(yong)對半補(bu)(bu)償(chang)，住院醫(yi)(yi)療費(fei)用(yong)補(bu)(bu)償(chang)最高(gao)可補(bu)(bu)償(chang)90%。到目(mu)前為(wei)止，揚中市本(ben)地(di)學(xue)生(sheng)初步實(shi)現人(ren)人(ren)享(xiang)有基本(ben)醫(yi)(yi)療保(bao)障。

揚中市(shi)對于新(xin)生(sheng)兒，自出(chu)(chu)生(sheng)15個工作日內，家長可(ke)憑(ping)醫學出(chu)(chu)生(sheng)證明，為(wei)新(xin)生(sheng)兒參(can)加(jia)居(ju)民醫保(bao)，自出(chu)(chu)生(sheng)之(zhi)日起的藥費可(ke)納入補(bu)償范(fan)圍。

廣大(da)的(de)(de)外來務(wu)工(gong)人員。這一(yi)群體(ti)往(wang)往(wang)因為一(yi)紙戶(hu)籍的(de)(de)限制，難以享受到跟本地人同等(deng)的(de)(de)醫(yi)療(liao)(liao)保(bao)(bao)障(zhang)、子女就學等(deng)同城待(dai)遇。揚(yang)(yang)中(zhong)市目前共(gong)有流動性人口5萬余人，外來務(wu)工(gong)人員的(de)(de)醫(yi)療(liao)(liao)保(bao)(bao)障(zhang)問題一(yi)直是市委、市政府牽掛、關心的(de)(de)事，在本市居(ju)民(min)初步實現(xian)“人人享有基本醫(yi)療(liao)(liao)保(bao)(bao)障(zhang)”目標后，在市委、市政府的(de)(de)支持(chi)及推動下，揚(yang)(yang)中(zhong)市醫(yi)保(bao)(bao)中(zhong)心不(bu)斷(duan)加大(da)擴(kuo)面力度，讓越來越多(duo)的(de)(de)在揚(yang)(yang)務(wu)工(gong)人員及其子女加入到居(ju)民(min)醫(yi)保(bao)(bao)的(de)(de)隊伍(wu)中(zhong)來，與(yu)本地市民(min)一(yi)樣享受“同城待(dai)遇”。

三、建立多層次醫療保障

2005年(nian)，我市(shi)在實施城鎮(zhen)職工(gong)基本醫(yi)(yi)療(liao)保(bao)險(xian)、住院醫(yi)(yi)療(liao)保(bao)險(xian)、合作醫(yi)(yi)療(liao)保(bao)險(xian)的基礎上，建立了醫(yi)(yi)療(liao)救(jiu)助制(zhi)度(du)，構筑(zhu)起多層(ceng)次醫(yi)(yi)療(liao)保(bao)障(zhang)(zhang)體系中(zhong)的最(zui)后一(yi)道保(bao)護屏(ping)障(zhang)(zhang)。

經過多年(nian)的(de)(de)運作，目前，揚(yang)中(zhong)市醫療救助由(you)市財政按人(ren)均6元標準撥款(kuan)設立專項(xiang)基(ji)金(jin)，全年(nian)實(shi)際籌集基(ji)金(jin)198萬元。救助內容(rong)包括兩大項(xiang)：一(yi)是由(you)財政扶持特困(kun)人(ren)員(yuan)參加居民基(ji)本醫療保(bao)險(xian)；二是特困(kun)人(ren)員(yuan)在獲得常(chang)規(gui)保(bao)障待(dai)遇的(de)(de)基(ji)礎(chu)上，享受醫療救助待(dai)遇。

從2004年以來(lai)的(de)10年里，我市財政累計投(tou)(tou)入429萬元(yuan)，扶持53042人次參(can)保；累計投(tou)(tou)入889萬元(yuan)設(she)立醫療救助專項基金(jin)，8869人次獲得(de)了866.58萬元(yuan)的(de)醫療救助。

“專(zhuan)款(kuan)專(zhuan)用，應享(xiang)盡(jin)享(xiang)”是(shi)揚中市(shi)醫療救助(zhu)的最(zui)大特點。為避免“窮人繳錢、富人看(kan)病”現象的發生，揚中市(shi)醫保(bao)中心每年都會聯合村(cun)（社區）對(dui)大額費用患者經(jing)濟承受能力等基本情況(kuang)進行嚴(yan)格認證，將個人自付金額雖然較多，但家(jia)庭條(tiao)件優越的人員排除在救助(zhu)范圍(wei)之外。

以2014年為例，全(quan)市救助(zhu)職工(gong)醫保(bao)66人(ren)，居(ju)民醫保(bao)153人(ren)，這(zhe)219名患者醫療費用(yong)在得到常(chang)規報銷的基礎上，每人(ren)還額外(wai)得到了2000-10000元不等的醫療救助(zhu)。

醫(yi)療(liao)保險的(de)目(mu)標是讓更(geng)多的(de)人(ren)(ren)享(xiang)有更(geng)高層次保障。2013年我(wo)市還進一步擴大了殘(can)疾人(ren)(ren)醫(yi)保報(bao)(bao)銷康復項目(mu)。 新增(zeng)六(liu)類殘(can)疾人(ren)(ren)員康復項目(mu)輔助器(qi)具納(na)入醫(yi)保報(bao)(bao)銷范疇(chou)，由醫(yi)保基(ji)金按一定(ding)比例(li)“買單(dan)”。據測算，這次“擴容(rong)”將會給全市200余名符合條件的(de)人(ren)(ren)員帶來福(fu)音。

四、加強監管，規范醫療(liao)服(fu)務行為

十年來(lai)，居民醫保(bao)(bao)(bao)基(ji)金的(de)發展，一方面(mian)是揚中市(shi)醫療保(bao)(bao)(bao)險(xian)制度(du)體(ti)系和各(ge)項政策(ce)措施不斷(duan)健(jian)全完善(shan)，保(bao)(bao)(bao)障范(fan)圍已(yi)覆蓋全民，待遇水平不斷(duan)提高，網(wang)上結算快捷方便，減輕了(le)百姓看病就醫負(fu)(fu)擔。另一方面(mian)，在方便就醫的(de)同時，一些參保(bao)(bao)(bao)人(ren)(ren)(ren)員(yuan)、定點醫院，違反醫保(bao)(bao)(bao)規定，過度(du)檢查治(zhi)療、使用貴重藥品，既加(jia)重了(le)醫保(bao)(bao)(bao)基(ji)金的(de)支付壓力，又加(jia)重了(le)參保(bao)(bao)(bao)人(ren)(ren)(ren)員(yuan)的(de)個人(ren)(ren)(ren)負(fu)(fu)擔。

為(wei)(wei)進一步(bu)規(gui)范基本醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)保險就(jiu)醫(yi)(yi)(yi)(yi)診療(liao)(liao)(liao)(liao)(liao)(liao)行(xing)(xing)為(wei)(wei)，管好(hao)用好(hao)醫(yi)(yi)(yi)(yi)保基金，維護好(hao)廣(guang)大(da)(da)參保群眾(zhong)的(de)(de)(de)醫(yi)(yi)(yi)(yi)保權益，市(shi)(shi)揚中市(shi)(shi)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)保險管理(li)中心通(tong)過(guo)與定(ding)(ding)點(dian)(dian)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)機(ji)構(gou)(gou)簽訂服務(wu)(wu)協議，加(jia)強了對(dui)(dui)(dui)這些機(ji)構(gou)(gou)的(de)(de)(de)服務(wu)(wu)管理(li)和監督。為(wei)(wei)了確保參保人(ren)員(yuan)發生(sheng)的(de)(de)(de)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)費(fei)支(zhi)出(chu)真(zhen)實、合理(li)，對(dui)(dui)(dui)參保住院(yuan)(yuan)人(ren)員(yuan)進行(xing)(xing)不定(ding)(ding)期抽查(cha)(cha)(cha)(cha)，并派醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)專家審核(he)病歷記載(zai)的(de)(de)(de)病史，判(pan)斷病人(ren)是(shi)否達(da)(da)到(dao)(dao)了住院(yuan)(yuan)指(zhi)標。對(dui)(dui)(dui)參保人(ren)員(yuan)在醫(yi)(yi)(yi)(yi)院(yuan)(yuan)發生(sheng)的(de)(de)(de)特(te)檢項目設立(li)了考(kao)核(he)標準，對(dui)(dui)(dui)達(da)(da)不到(dao)(dao)考(kao)核(he)標準的(de)(de)(de)費(fei)用由(you)醫(yi)(yi)(yi)(yi)院(yuan)(yuan)承擔。建立(li)定(ding)(ding)點(dian)(dian)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)機(ji)構(gou)(gou)檢查(cha)(cha)(cha)(cha)考(kao)核(he)機(ji)制，嚴格履行(xing)(xing)定(ding)(ding)點(dian)(dian)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)服務(wu)(wu)協議，對(dui)(dui)(dui)違(wei)約、違(wei)規(gui)行(xing)(xing)為(wei)(wei)嚴肅處(chu)理(li)，對(dui)(dui)(dui)增加(jia)病人(ren)負擔，不合理(li)的(de)(de)(de)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)行(xing)(xing)為(wei)(wei)加(jia)大(da)(da)處(chu)罰力度(du)。對(dui)(dui)(dui)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)違(wei)規(gui)行(xing)(xing)為(wei)(wei)多(duo)發的(de)(de)(de)環節，采取突擊檢查(cha)(cha)(cha)(cha) 、重點(dian)(dian)核(he)查(cha)(cha)(cha)(cha)、定(ding)(ding)期考(kao)核(he)和費(fei)用撥付(fu)相(xiang)結合；媒(mei)體(ti)報道與群眾(zhong)監督、公(gong)開(kai)公(gong)示等(deng)方法，對(dui)(dui)(dui)查(cha)(cha)(cha)(cha)處(chu)的(de)(de)(de)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)違(wei)規(gui)行(xing)(xing)為(wei)(wei)嚴肅處(chu)理(li)，引導定(ding)(ding)點(dian)(dian)醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)機(ji)構(gou)(gou)自(zi)覺(jue)規(gui)范醫(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)(liao)(liao)服務(wu)(wu)行(xing)(xing)為(wei)(wei)。

第二是制定科(ke)學合理的(de)醫(yi)(yi)保(bao)結(jie)(jie)算(suan)(suan)方案。今年，我(wo)們根據基金收(shou)入(ru)情況，實行總(zong)量(liang)控制，采(cai)取總(zong)額預算(suan)(suan)與均次考核(he)相結(jie)(jie)合的(de)辦(ban)法，將全年指(zhi)標(biao)分解落實到各醫(yi)(yi)院，采(cai)取節余(yu)獎(jiang)勵超(chao)支扣減的(de)辦(ban)法，鼓勵各醫(yi)(yi)院強化(hua)管理，共同使用(yong)好(hao)有限(xian)的(de)醫(yi)(yi)保(bao)基金。

第(di)三是加強轉外就醫(yi)(yi)管(guan)(guan)理(li)(li)。我(wo)市2014年為了進一步規(gui)范基(ji)本醫(yi)(yi)療保險參保人員外地就診管(guan)(guan)理(li)(li)，制定了《揚中市基(ji)本醫(yi)(yi)療保險外地就診管(guan)(guan)理(li)(li)辦法》，使轉外就醫(yi)(yi)制度化。

五、加大(da)宣(xuan)傳(chuan)力(li)度，增(zeng)大(da)影響力(li)

宣傳工作是(shi)我市(shi)居(ju)民醫(yi)保(bao)(bao)(bao)工作的重要環節，我們一直秉承“宣傳出效益”的方針，在(zai)實(shi)際工作開(kai)展中，注重從(cong)多方面、多層次做好宣傳工作。定期(qi)對外公布居(ju)民醫(yi)療(liao)保(bao)(bao)(bao)險基金運行(xing)情況，并多次對享受過費(fei)用補償的人員進(jin)行(xing)采訪和報道(dao)，使參保(bao)(bao)(bao)居(ju)民能(neng)切實(shi)感受到(dao)居(ju)民醫(yi)保(bao)(bao)(bao)政(zheng)策(ce)帶來的看得見、摸得著的實(shi)惠，從(cong)而積極主動的參加(jia)和支持居(ju)民醫(yi)保(bao)(bao)(bao)。同時，在(zai)每年(nian)收繳保(bao)(bao)(bao)費(fei)期(qi)間，發放《告居(ju)民書》，以問(wen)(wen)答的方式，詳細解讀當(dang)年(nian)的居(ju)民醫(yi)保(bao)(bao)(bao)政(zheng)策(ce)，并通過廣播、電(dian)視(shi)、報紙(zhi)等途(tu)徑，解答熱(re)點問(wen)(wen)題，使參保(bao)(bao)(bao)居(ju)民對政(zheng)策(ce)能(neng)做到(dao)心中有數。

六、創新繳費結算方式，保證基金安全

2010年(nian)7月起(qi)，我市居(ju)民(min)(min)醫(yi)療保(bao)(bao)(bao)(bao)險第二(er)(er)代(dai)身份證結算(suan)系統(tong)(tong)正式啟用(yong)，參保(bao)(bao)(bao)(bao)居(ju)民(min)(min)在本市和(he)鎮(zhen)江五家(jia)特(te)約醫(yi)院看(kan)病，憑第二(er)(er)代(dai)身份證可以現看(kan)現報。2011年(nian)我市與農(nong)村商(shang)業銀(yin)行(xing)合作，開發了(le)銀(yin)行(xing)繳費系統(tong)(tong)，續保(bao)(bao)(bao)(bao)人員(yuan)可在規定時間內憑二(er)(er)代(dai)身份證、居(ju)民(min)(min)保(bao)(bao)(bao)(bao)險參保(bao)(bao)(bao)(bao)證在我市農(nong)村商(shang)業銀(yin)行(xing)19家(jia)網點繳納保(bao)(bao)(bao)(bao)費，基(ji)金及時到帳，減少了(le)社(she)(she)區和(he)村干部(bu)的(de)(de)工作量，保(bao)(bao)(bao)(bao)證了(le)基(ji)金的(de)(de)安(an)全性和(he)信息的(de)(de)準確性，同時，也(ye)方便了(le)參保(bao)(bao)(bao)(bao)居(ju)民(min)(min)繳費，也(ye)在一(yi)定程(cheng)度上(shang)促進了(le)參保(bao)(bao)(bao)(bao)人員(yuan)主動(dong)繳費的(de)(de)意識。2015年(nian)隨著(zhu)全市金保(bao)(bao)(bao)(bao)工程(cheng)的(de)(de)實(shi)施，全市所(suo)有參保(bao)(bao)(bao)(bao)人員(yuan)辦理了(le)統(tong)(tong)一(yi)的(de)(de)社(she)(she)會(hui)保(bao)(bao)(bao)(bao)障卡。

七、與商保公司(si)共擔風險

創新居(ju)民(min)基(ji)本(ben)醫(yi)(yi)療(liao)保(bao)(bao)險(xian)(xian)(xian)與(yu)商(shang)業保(bao)(bao)險(xian)(xian)(xian)機構合的經(jing)辦的模式，以期能(neng)達到風(feng)險(xian)(xian)(xian)共(gong)擔、費用共(gong)管、運營(ying)雙營(ying)的目(mu)標。目(mu)前，揚(yang)中市已在居(ju)民(min)基(ji)本(ben)醫(yi)(yi)療(liao)保(bao)(bao)險(xian)(xian)(xian)中的學生保(bao)(bao)險(xian)(xian)(xian)、意(yi)外傷(shang)害保(bao)(bao)險(xian)(xian)(xian)等(deng)領域(yu)與(yu)商(shang)業保(bao)(bao)險(xian)(xian)(xian)公司展開合作，并取得(de)了較好(hao)的成效，積累(lei)了合作經(jing)驗。2014年又(you)將城鄉(xiang)居(ju)民(min)大病保(bao)(bao)險(xian)(xian)(xian)向商(shang)保(bao)(bao)公司進行再保(bao)(bao)險(xian)(xian)(xian)，發揮其專業醫(yi)(yi)療(liao)監管的優勢，分(fen)擔醫(yi)(yi)保(bao)(bao)基(ji)金超支的風(feng)險(xian)(xian)(xian)。

在我市醫保(bao)中(zhong)心，有句人(ren)人(ren)熟知的(de)(de)“工作標準”：要看(kan)群眾高興不(bu)(bu)高興，答應不(bu)(bu)答應，滿意不(bu)(bu)滿意。醫保(bao)上下嚴格按照這樣的(de)(de)高標準，開展(zhan)“對黨(dang)負責(ze)，讓人(ren)民滿意”的(de)(de)高效優質服務(wu)，讓老百姓真(zhen)正感受到人(ren)性化服務(wu)和文明服務(wu)的(de)(de)無處(chu)不(bu)(bu)在。

篇4

一、優化(hua)流程(cheng)，做好(hao)基礎業務管理工(gong)作(zuo)

（一(yi)(yi)）學習并理(li)順養(yang)老、醫療、生(sheng)育等(deng)保(bao)(bao)險政策(ce)，及時通知，做好在(zai)職(zhi)工(gong)中(zhong)的宣傳及政策(ce)解讀(du)工(gong)作(zuo)。為最大(da)程度方便(bian)一(yi)(yi)線職(zhi)工(gong)了解和辦(ban)理(li)社(she)(she)保(bao)(bao)業務(wu)，將社(she)(she)保(bao)(bao)政策(ce)與辦(ban)理(li)流(liu)程制作(zuo)成電子版業務(wu)指(zhi)南，如《職(zhi)工(gong)醫保(bao)(bao)就醫與報銷辦(ban)理(li)指(zhi)南》《社(she)(she)保(bao)(bao)卡服務(wu)指(zhi)南》《職(zhi)工(gong)生(sheng)育保(bao)(bao)險待(dai)遇辦(ban)理(li)指(zhi)南》《工(gong)傷申報流(liu)程》等(deng)資料(liao)下發到各二級單位，獲(huo)得(de)職(zhi)工(gong)一(yi)(yi)致(zhi)好評(ping)。

 （二）積極(ji)配合公司ERP信(xin)(xin)息(xi)(xi)系統(tong)(tong)架設，提(ti)高了工(gong)作效率，統(tong)(tong)一了工(gong)作平臺，確(que)保快速準確(que)的(de)(de)完成工(gong)作業務(wu)。自2019年(nian)初開(kai)始(shi)，在上級領導的(de)(de)指導下多(duo)次(ci)與(yu)信(xin)(xin)息(xi)(xi)計量部、山信(xin)(xin)軟件公司交流，為ERP信(xin)(xin)息(xi)(xi)系統(tong)(tong)架構提(ti)出(chu)合理需求(qiu)，配合提(ti)供(gong)系統(tong)(tong)開(kai)發的(de)(de)思(si)路，完成子模塊(kuai)建設、基礎(chu)數據的(de)(de)采集、系統(tong)(tong)分步測試等(deng)一系列工(gong)作。

（三）結合實際，做好特殊(shu)(shu)(shu)工(gong)種(zhong)界定(ding)工(gong)作，為職工(gong)退休、退養條件管理(li)奠定(ding)基礎。根(gen)據公司現有工(gong)種(zhong)崗位的(de)工(gong)作環境、勞動強度等情況，對照國家(jia)特殊(shu)(shu)(shu)崗位工(gong)種(zhong)名(ming)錄(lu)，參照濟鋼(gang)、萊鋼(gang)現行政(zheng)策，制(zhi)定(ding)公司特殊(shu)(shu)(shu)工(gong)種(zhong)名(ming)錄(lu)初(chu)稿，報日照市社(she)保局審核，現已全面(mian)完(wan)成《##單位特殊(shu)(shu)(shu)工(gong)種(zhong)名(ming)錄(lu)》制(zhi)定(ding)工(gong)作。

（四）做(zuo)好穩(wen)崗(gang)(gang)補(bu)貼(tie)(tie)(tie)申(shen)報，充分利用政(zheng)策維護公(gong)司利益。依(yi)據日照市(shi)關(guan)于(yu)(yu)《關(guan)于(yu)(yu)申(shen)報失業(ye)(ye)保險穩(wen)崗(gang)(gang)補(bu)貼(tie)(tie)(tie)的通(tong)知》等文件規定(ding)精(jing)神，根據公(gong)司2018年度繳納(na)失業(ye)(ye)保險實(shi)際情況，結合公(gong)司采取有(you)效措施不(bu)裁員、不(bu)減(jian)員、穩(wen)定(ding)就(jiu)業(ye)(ye)崗(gang)(gang)位(wei)為山東(dong)省化解鋼鐵過剩產能、淘汰落后產能和(he)(he)節能減(jian)排做(zuo)出的積極的貢獻，按照山東(dong)省關(guan)于(yu)(yu)穩(wen)崗(gang)(gang)補(bu)貼(tie)(tie)(tie)有(you)關(guan)規定(ding)，積極申(shen)請補(bu)貼(tie)(tie)(tie)。經日照市(shi)勞動和(he)(he)社(she)會保障(zhang)局審核批準(zhun)我(wo)公(gong)司穩(wen)崗(gang)(gang)補(bu)貼(tie)(tie)(tie)，并嚴格按照相關(guan)要求(qiu)，專項使用此類補(bu)貼(tie)(tie)(tie)，確保穩(wen)定(ding)就(jiu)業(ye)(ye)崗(gang)(gang)位(wei)。

（五(wu)）落實服(fu)務職(zhi)(zhi)工(gong)(gong)的宗(zong)旨，完成社(she)(she)保(bao)基數轉換(huan)及補充醫(yi)療保(bao)險管理辦法(fa)制定。根據統計的2018年度(du)職(zhi)(zhi)工(gong)(gong)平(ping)(ping)均工(gong)(gong)資，及日照市2018年度(du)企業職(zhi)(zhi)工(gong)(gong)平(ping)(ping)均工(gong)(gong)資標準，按照日照市人社(she)(she)局、住房(fang)公(gong)積金(jin)管理中(zhong)心的要求，及時(shi)完成社(she)(she)會保(bao)險及住房(fang)公(gong)積金(jin)繳存基數的轉換(huan)工(gong)(gong)作。同(tong)時(shi)在(zai)2019年完成制定《企業補充醫(yi)療保(bao)險管理辦法(fa)》，辦法(fa)的實施降低了職(zhi)(zhi)工(gong)(gong)醫(yi)療負擔，提高(gao)了職(zhi)(zhi)工(gong)(gong)醫(yi)療保(bao)障水平(ping)(ping)。

二、“互聯網＋”辦公，不(bu)斷創新服務(wu)模式(shi)

（一(yi)）優質服(fu)務“不見(jian)面”，改(gai)革創新“碼上辦”。根據市(shi)人(ren)社局(ju)加大(da)社會保(bao)障卡(ka)系統建設(she)力度等有關規定及政策，結合(he)(he)當前疫情防控(kong)形勢，充(chong)分(fen)落(luo)實社保(bao)業(ye)務“網(wang)(wang)上辦、掌上辦、自(zi)(zi)助辦”。2019年初以來，在社保(bao)卡(ka)的辦理(li)、領(ling)取(qu)、使用等方(fang)面實現(xian)“互(hu)聯(lian)網(wang)(wang)＋”模式，職(zhi)工信息全(quan)部通過(guo)網(wang)(wang)絡上傳，原申領(ling)社會保(bao)障卡(ka)的“申請、領(ling)取(qu)、激活”模式改(gai)為在合(he)(he)作銀行(xing)現(xian)場辦理(li)，現(xian)場激活，職(zhi)工只需一(yi)次“跑(pao)腿”即可辦好。同時，面向廣(guang)發職(zhi)工宣(xuan)傳“日照人(ren)社”手(shou)機(ji)APP、“日照人(ren)社”微信公眾(zhong)號、自(zi)(zi)助服(fu)務一(yi)體機(ji)等渠(qu)道查詢、辦理(li)社會保(bao)險、社會保(bao)障卡(ka)業(ye)務，極大(da)程度上方(fang)便了辦理(li)相(xiang)關業(ye)務的職(zhi)工。

（二）愛崗敬業(ye)、熱情服(fu)務。始終(zhong)以“熱情、周(zhou)到、和(he)氣、文明”為(wei)(wei)服(fu)務宗旨(zhi)，保(bao)(bao)(bao)(bao)障員(yuan)(yuan)(yuan)工(gong)(gong)合法權益。近兩年，公司新進(jin)員(yuan)(yuan)(yuan)工(gong)(gong)人(ren)數眾多(duo)(duo)(duo)，且進(jin)廠報到集(ji)中，保(bao)(bao)(bao)(bao)險的轉移、立(li)戶(hu)及(ji)繳(jiao)費工(gong)(gong)作(zuo)任務重，涉及(ji)濟南、萊蕪、日照、淄博等(deng)多(duo)(duo)(duo)個地(di)市(shi)的社(she)保(bao)(bao)(bao)(bao)轉移工(gong)(gong)作(zuo)，要求需在一(yi)定時限內辦理社(she)保(bao)(bao)(bao)(bao)轉移工(gong)(gong)作(zuo)，為(wei)(wei)保(bao)(bao)(bao)(bao)證員(yuan)(yuan)(yuan)工(gong)(gong)社(she)保(bao)(bao)(bao)(bao)的正常繳(jiao)費，頻繁多(duo)(duo)(duo)次的與多(duo)(duo)(duo)地(di)市(shi)的社(she)保(bao)(bao)(bao)(bao)部門聯系，不(bu)等(deng)不(bu)靠，主動完成(cheng)各項社(she)保(bao)(bao)(bao)(bao)轉移等(deng)工(gong)(gong)作(zuo)。2019年全(quan)年共完成(cheng)318名職(zhi)工(gong)(gong)社(she)保(bao)(bao)(bao)(bao)立(li)戶(hu)，為(wei)(wei)新進(jin)人(ren)員(yuan)(yuan)(yuan)辦理職(zhi)工(gong)(gong)社(she)保(bao)(bao)(bao)(bao)卡，轉移1200多(duo)(duo)(duo)名職(zhi)工(gong)(gong)的參保(bao)(bao)(bao)(bao)信息及(ji)醫保(bao)(bao)(bao)(bao)賬戶(hu)資金，有力(li)的保(bao)(bao)(bao)(bao)障了員(yuan)(yuan)(yuan)工(gong)(gong)權益。

（三(san)）廣(guang)泛利用(yong)宣傳(chuan)載(zai)體，做好工(gong)(gong)(gong)傷(shang)預(yu)防(fang)(fang)(fang)工(gong)(gong)(gong)作。根據山東省、日照市開展(zhan)(zhan)工(gong)(gong)(gong)傷(shang)預(yu)防(fang)(fang)(fang)工(gong)(gong)(gong)作的(de)(de)要(yao)求，完成制(zhi)定(ding)##單(dan)位《工(gong)(gong)(gong)傷(shang)預(yu)防(fang)(fang)(fang)實(shi)施方案》，落實(shi)各(ge)項工(gong)(gong)(gong)傷(shang)保險(xian)政(zheng)策和安全生(sheng)產措施，從源頭上(shang)減少工(gong)(gong)(gong)傷(shang)事(shi)故的(de)(de)發(fa)生(sheng)，從根本上(shang)保障職(zhi)工(gong)(gong)(gong)的(de)(de)生(sheng)命(ming)安全和健康權益，積極穩(wen)妥推(tui)進工(gong)(gong)(gong)傷(shang)預(yu)防(fang)(fang)(fang)工(gong)(gong)(gong)作。同時2019年在(zai)公(gong)司微信公(gong)眾號推(tui)送工(gong)(gong)(gong)傷(shang)預(yu)防(fang)(fang)(fang)知識，開展(zhan)(zhan)政(zheng)策咨詢(xun)互(hu)動(dong)活(huo)動(dong)7場；利用(yong)電(dian)子(zi)屏、班車(che)車(che)載(zai)電(dian)子(zi)屏等方式，滾動(dong)播放(fang)工(gong)(gong)(gong)傷(shang)預(yu)防(fang)(fang)(fang)宣傳(chuan)標(biao)語，播放(fang)工(gong)(gong)(gong)傷(shang)預(yu)防(fang)(fang)(fang)宣傳(chuan)片(pian)、公(gong)益廣(guang)告、專題(ti)片(pian)等。通過活(huo)動(dong)的(de)(de)開展(zhan)(zhan)，在(zai)全公(gong)司范圍內營造了全員(yuan)支持、廣(guang)泛參與的(de)(de)工(gong)(gong)(gong)傷(shang)預(yu)防(fang)(fang)(fang)氛圍。

三、立足(zu)自身(shen)求發(fa)展，巾幗崗(gang)位建功

（一）在(zai)上級領導(dao)的(de)指(zhi)導(dao)下積極參與(yu)“文(wen)明窗口(kou)(kou)”建設，以窗口(kou)(kou)建設為(wei)契機，大大提(ti)(ti)升了(le)服務(wu)管(guan)理水(shui)平。從初始的(de)微笑服務(wu)、便(bian)捷服務(wu)，發展到現在(zai)的(de)規范服務(wu)程(cheng)序，提(ti)(ti)高隊伍素質(zhi)，實(shi)施優質(zhi)服務(wu)，使(shi)“文(wen)明窗口(kou)(kou)”創(chuang)建工作(zuo)常(chang)抓(zhua)常(chang)新(xin)，留(liu)下了(le)不斷(duan)在(zai)創(chuang)新(xin)中(zhong)發展的(de)堅實(shi)足(zu)跡。

篇5

一、建立多層次的(de)醫療(liao)保險體系

根(gen)據實際(ji)情(qing)況，我(wo)國的多層次的醫(yi)療保險體系應包括以下三個層次：

1.基(ji)本(ben)醫(yi)(yi)(yi)療(liao)(liao)保(bao)險(xian)(xian)。這是多層(ceng)次的醫(yi)(yi)(yi)療(liao)(liao)保(bao)險(xian)(xian)體(ti)系(xi)的基(ji)礎，也是國家(jia)醫(yi)(yi)(yi)療(liao)(liao)政策(ce)的重要組成(cheng)部分，屬于(yu)法定性質的政府行(xing)為(wei)，以強制性實施為(wei)主，財源主要來自強制籌(chou)集的保(bao)險(xian)(xian)費。基(ji)本(ben)醫(yi)(yi)(yi)療(liao)(liao)保(bao)險(xian)(xian)堅持“低水平，廣覆(fu)蓋(gai)”的原則(ze)，強調“公平優先、兼顧(gu)效率”，只承擔基(ji)本(ben)醫(yi)(yi)(yi)療(liao)(liao)的保(bao)障職(zhi)責(ze)，即限于(yu)提供(gong)適應絕大多數參保(bao)職(zhi)工(gong)必要醫(yi)(yi)(yi)療(liao)(liao)需(xu)求的、醫(yi)(yi)(yi)療(liao)(liao)服務機構采用成(cheng)熟的和(he)適宜技術所能(neng)提供(gong)的、醫(yi)(yi)(yi)療(liao)(liao)保(bao)險(xian)(xian)基(ji)金(jin)有能(neng)力支付費用的醫(yi)(yi)(yi)療(liao)(liao)服務。

2.補(bu)(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)。這(zhe)是(shi)完(wan)整(zheng)的(de)(de)(de)(de)(de)(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)體(ti)系的(de)(de)(de)(de)(de)(de)(de)(de)不(bu)(bu)(bu)可缺少的(de)(de)(de)(de)(de)(de)(de)(de)組成(cheng)部分，是(shi)在(zai)(zai)基(ji)(ji)(ji)(ji)本(ben)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)的(de)(de)(de)(de)(de)(de)(de)(de)基(ji)(ji)(ji)(ji)礎上(shang)，在(zai)(zai)經濟效益許可的(de)(de)(de)(de)(de)(de)(de)(de)條件下，由企(qi)業（行(xing)業）為(wei)職(zhi)工(gong)、職(zhi)工(gong)為(wei)個(ge)人(ren)自愿出(chu)資組成(cheng)補(bu)(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)基(ji)(ji)(ji)(ji)金，為(wei)彌補(bu)(bu)(bu)(bu)基(ji)(ji)(ji)(ji)本(ben)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)的(de)(de)(de)(de)(de)(de)(de)(de)水平不(bu)(bu)(bu)足以(yi)(yi)支付(fu)巨額醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)費而(er)(er)建(jian)立(li)(li)的(de)(de)(de)(de)(de)(de)(de)(de)補(bu)(bu)(bu)(bu)充(chong)(chong)性醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)形式(shi)。在(zai)(zai)我國現(xian)階段(duan)，應抓緊建(jian)立(li)(li)的(de)(de)(de)(de)(de)(de)(de)(de)補(bu)(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)形式(shi)有(you)：一是(shi)“超(chao)(chao)大(da)(da)病(bing)(bing)”補(bu)(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)。基(ji)(ji)(ji)(ji)本(ben)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)保(bao)(bao)(bao)(bao)的(de)(de)(de)(de)(de)(de)(de)(de)是(shi)基(ji)(ji)(ji)(ji)本(ben)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)，但(dan)是(shi)超(chao)(chao)過最(zui)(zui)高支付(fu)限額的(de)(de)(de)(de)(de)(de)(de)(de)病(bing)(bing)例(li)(li)又是(shi)客觀存在(zai)(zai)的(de)(de)(de)(de)(de)(de)(de)(de)，盡管其發(fa)生的(de)(de)(de)(de)(de)(de)(de)(de)概率較(jiao)低，但(dan)費用(yong)很(hen)大(da)(da)，致(zhi)使單位(wei)和個(ge)人(ren)均難以(yi)(yi)承受(shou)。對(dui)于這(zhe)些“超(chao)(chao)大(da)(da)病(bing)(bing)”的(de)(de)(de)(de)(de)(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)問題，既不(bu)(bu)(bu)能(neng)一推了之(zhi)，更不(bu)(bu)(bu)應該把這(zhe)個(ge)包袱再(zai)推給用(yong)人(ren)單位(wei)，最(zui)(zui)佳的(de)(de)(de)(de)(de)(de)(de)(de)解決(jue)辦法應是(shi)面向統籌地區建(jian)立(li)(li)“超(chao)(chao)大(da)(da)病(bing)(bing)”補(bu)(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)，主要用(yong)于解決(jue)基(ji)(ji)(ji)(ji)本(ben)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)封頂線以(yi)(yi)上(shang)的(de)(de)(de)(de)(de)(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)費用(yong)，減輕(qing)重病(bing)(bing)職(zhi)工(gong)負擔，保(bao)(bao)(bao)(bao)障其基(ji)(ji)(ji)(ji)本(ben)生活(huo)；二是(shi)“大(da)(da)病(bing)(bing)”補(bu)(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)。基(ji)(ji)(ji)(ji)本(ben)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)險(xian)采用(yong)統帳結(jie)合方(fang)式(shi)實施，其中(zhong)社會統籌基(ji)(ji)(ji)(ji)金要確定起付(fu)標(biao)準和最(zui)(zui)高支付(fu)限額，起付(fu)標(biao)準以(yi)(yi)上(shang)和最(zui)(zui)高支付(fu)限額以(yi)(yi)下的(de)(de)(de)(de)(de)(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)費用(yong)，以(yi)(yi)統籌基(ji)(ji)(ji)(ji)金支付(fu)為(wei)主，但(dan)個(ge)人(ren)同樣要負擔相(xiang)應比重。盡管相(xiang)對(dui)統籌支付(fu)而(er)(er)言(yan)個(ge)人(ren)負擔比例(li)(li)較(jiao)小，但(dan)由于醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)費用(yong)相(xiang)對(dui)較(jiao)大(da)(da)，對(dui)于因病(bing)(bing)不(bu)(bu)(bu)能(neng)參加工(gong)作、工(gong)資收入明顯下降的(de)(de)(de)(de)(de)(de)(de)(de)職(zhi)工(gong)本(ben)人(ren)和家庭來說，還是(shi)困難重重。為(wei)了減輕(qing)重病(bing)(bing)職(zhi)工(gong)負擔，保(bao)(bao)(bao)(bao)障其基(ji)(ji)(ji)(ji)本(ben)生活(huo)，企(qi)業（行(xing)業）在(zai)(zai)有(you)條件的(de)(de)(de)(de)(de)(de)(de)(de)情(qing)況下，有(you)必要建(jian)立(li)(li)職(zhi)工(gong)大(da)(da)病(bing)(bing)專項金，實行(xing)統籌使用(yong)，對(dui)困難者(zhe)予以(yi)(yi)資助(zhu)。

3.商業醫(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)。這是(shi)多層(ceng)次(ci)的(de)(de)(de)醫(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)體(ti)系中較(jiao)(jiao)為規(gui)范、起補缺(que)和(he)提(ti)高作用(yong)的(de)(de)(de)層(ceng)次(ci)，是(shi)被保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人在(zai)投(tou)(tou)保(bao)(bao)(bao)(bao)后，在(zai)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)期內因(yin)疾病(bing)(bing)(bing)、生育(yu)或身體(ti)受(shou)到傷(shang)害時，由保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)人給付保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)金的(de)(de)(de)一(yi)(yi)種(zhong)(zhong)(zhong)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)。在(zai)這一(yi)(yi)領域由人們(men)自(zi)由選擇，堅持“效率優(you)先、兼顧公平(ping)”的(de)(de)(de)原則。隨著基(ji)(ji)本(ben)(ben)醫(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)制度(du)的(de)(de)(de)建立，當前應(ying)重點突出主要(yao)(yao)的(de)(de)(de)險(xian)(xian)(xian)(xian)種(zhong)(zhong)(zhong)有(you)：（1）特種(zhong)(zhong)(zhong)疾病(bing)(bing)(bing)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)。針(zhen)對一(yi)(yi)些(xie)風險(xian)(xian)(xian)(xian)容易(yi)預測、發生率較(jiao)(jiao)低，但疾病(bing)(bing)(bing)費(fei)用(yong)較(jiao)(jiao)大的(de)(de)(de)疾病(bing)(bing)(bing)而設(she)計(ji)(ji)的(de)(de)(de)險(xian)(xian)(xian)(xian)種(zhong)(zhong)(zhong)，主要(yao)(yao)目的(de)(de)(de)是(shi)為了在(zai)發生災難性病(bing)(bing)(bing)癥時保(bao)(bao)(bao)(bao)障投(tou)(tou)保(bao)(bao)(bao)(bao)者的(de)(de)(de)治療，以(yi)免由于(yu)經濟原因(yin)使治療受(shou)到影響。比(bi)如腫瘤、心(xin)腦血管意(yi)外病(bing)(bing)(bing)癥。（2）康(kang)復(fu)保(bao)(bao)(bao)(bao)健醫(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)。主要(yao)(yao)為滿足一(yi)(yi)些(xie)高收(shou)入(ru)人群或團體(ti)超出基(ji)(ji)本(ben)(ben)醫(yi)療需求(qiu)以(yi)上的(de)(de)(de)高水平(ping)的(de)(de)(de)和(he)特殊保(bao)(bao)(bao)(bao)健的(de)(de)(de)醫(yi)療需求(qiu)而設(she)計(ji)(ji)的(de)(de)(de)險(xian)(xian)(xian)(xian)種(zhong)(zhong)(zhong)。如有(you)些(xie)病(bing)(bing)(bing)房(fang)的(de)(de)(de)設(she)施(shi)將比(bi)較(jiao)(jiao)豪華(hua)，相應(ying)的(de)(de)(de)收(shou)費(fei)標(biao)準也高，基(ji)(ji)本(ben)(ben)醫(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)不可能承擔這部分費(fei)用(yong)，部分高收(shou)入(ru)人群就可通過參加康(kang)復(fu)保(bao)(bao)(bao)(bao)健醫(yi)療保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)得到相應(ying)的(de)(de)(de)待遇。

二(er)、建立(li)合(he)理的醫(yi)療保險費用籌措(cuo)機制

基(ji)(ji)本(ben)(ben)(ben)醫療保險(xian)(xian)必須堅持“以收(shou)定支、收(shou)支平(ping)衡、略有節余(yu)”的(de)原(yuan)則，考慮在社(she)會(hui)主義初級階段，職(zhi)工(gong)的(de)收(shou)入水平(ping)并不高，財(cai)政收(shou)入極為(wei)有限(xian)，企(qi)業效益大多數處(chu)于(yu)較低水平(ping)的(de)現狀(zhuang)，本(ben)(ben)(ben)著“最(zui)基(ji)(ji)本(ben)(ben)(ben)的(de)籌(chou)資(zi)水平(ping)、最(zui)基(ji)(ji)本(ben)(ben)(ben)的(de)醫療服務”的(de)理(li)念(nian)，由(you)用(yong)(yong)人(ren)單位和職(zhi)工(gong)雙(shuang)方按工(gong)資(zi)的(de)一(yi)定比(bi)例(li)共同負擔(dan)。基(ji)(ji)本(ben)(ben)(ben)醫療保險(xian)(xian)實行社(she)會(hui)統籌(chou)和個(ge)人(ren)帳(zhang)(zhang)戶(hu)相結合，基(ji)(ji)本(ben)(ben)(ben)醫療保險(xian)(xian)金(jin)由(you)統籌(chou)基(ji)(ji)金(jin)和個(ge)人(ren)帳(zhang)(zhang)戶(hu)構(gou)成。職(zhi)工(gong)個(ge)人(ren)繳(jiao)(jiao)納的(de)醫療保險(xian)(xian)費，全部計入個(ge)人(ren)帳(zhang)(zhang)戶(hu)。用(yong)(yong)人(ren)單位繳(jiao)(jiao)納的(de)基(ji)(ji)本(ben)(ben)(ben)醫療保險(xian)(xian)費分為(wei)兩部分，一(yi)部分用(yong)(yong)于(yu)建(jian)立(li)統籌(chou)基(ji)(ji)金(jin)，一(yi)部分劃入個(ge)人(ren)帳(zhang)(zhang)戶(hu)，具(ju)體(ti)劃入比(bi)例(li)根據(ju)個(ge)人(ren)帳(zhang)(zhang)戶(hu)支付范圍(wei)和職(zhi)工(gong)年(nian)齡(ling)因素確定。

補(bu)充(chong)醫(yi)療(liao)保(bao)(bao)(bao)險(xian)和(he)商業醫(yi)療(liao)保(bao)(bao)(bao)險(xian)由(you)國家(jia)給予政(zheng)策，鼓(gu)勵用(yong)(yong)人單(dan)位和(he)個(ge)人積累，資金組(zu)合方式可以靈(ling)活多樣，可個(ge)人參保(bao)(bao)(bao)，可由(you)用(yong)(yong)人單(dan)位與個(ge)人各付一(yi)部分保(bao)(bao)(bao)險(xian)金，有(you)條件的(de)(de)單(dan)位也(ye)可全(quan)部由(you)用(yong)(yong)人單(dan)位為(wei)職工(gong)投(tou)保(bao)(bao)(bao)，并以此(ci)(ci)作為(wei)穩(wen)定(ding)(ding)職工(gong)、吸引(yin)人才的(de)(de)有(you)力(li)措施(shi)。在此(ci)(ci)，除了為(wei)保(bao)(bao)(bao)證國家(jia)公(gong)務管理的(de)(de)正常運(yun)行，由(you)財政(zheng)為(wei)國家(jia)公(gong)務員(yuan)提供一(yi)定(ding)(ding)的(de)(de)醫(yi)療(liao)補(bu)助(zhu)外，國家(jia)不為(wei)其(qi)他任何社會成員(yuan)支付保(bao)(bao)(bao)險(xian)費，但(dan)可通(tong)過有(you)關政(zheng)策鼓(gu)勵用(yong)(yong)人單(dan)位和(he)個(ge)人參與保(bao)(bao)(bao)險(xian)。其(qi)鼓(gu)勵政(zheng)策至少有(you)兩條：個(ge)人用(yong)(yong)于補(bu)充(chong)醫(yi)療(liao)保(bao)(bao)(bao)險(xian)和(he)商業醫(yi)療(liao)保(bao)(bao)(bao)險(xian)的(de)(de)收入免交(jiao)個(ge)人所(suo)得稅；用(yong)(yong)人單(dan)位用(yong)(yong)于補(bu)充(chong)醫(yi)療(liao)保(bao)(bao)(bao)險(xian)和(he)商業醫(yi)療(liao)保(bao)(bao)(bao)險(xian)的(de)(de)費用(yong)(yong)，可在稅前列(lie)支。

三、建立科學的醫(yi)療(liao)費用支付方式

醫療(liao)保(bao)險難搞(gao)，難就難在醫療(liao)費用(yong)(yong)的(de)(de)(de)支出控制。醫療(liao)消費具有即(ji)時性、難預測性、道德風險大的(de)(de)(de)特(te)點。一些試點城市的(de)(de)(de)社會(hui)統(tong)籌基金大量超支，都與缺乏有效的(de)(de)(de)醫療(liao)費用(yong)(yong)制約有很大關系。實(shi)踐證(zheng)明，建立科學的(de)(de)(de)醫療(liao)費用(yong)(yong)支付方式(shi)是醫療(liao)保(bao)險健(jian)康發(fa)展的(de)(de)(de)重(zhong)要環(huan)節(jie)。

1.制定基(ji)本(ben)(ben)醫(yi)(yi)(yi)(yi)療保險的(de)用藥(yao)(yao)、診(zhen)療和(he)醫(yi)(yi)(yi)(yi)療服(fu)務設(she)施的(de)標(biao)準。現代的(de)醫(yi)(yi)(yi)(yi)療科學技術發(fa)展很快，幾乎天(tian)天(tian)都有新藥(yao)(yao)、新的(de)診(zhen)療手段出現。基(ji)本(ben)(ben)醫(yi)(yi)(yi)(yi)療保險只(zhi)能根據保證基(ji)本(ben)(ben)醫(yi)(yi)(yi)(yi)療需求和(he)與醫(yi)(yi)(yi)(yi)療保險基(ji)金籌措(cuo)水(shui)平相適應來確定用藥(yao)(yao)、診(zhen)療和(he)醫(yi)(yi)(yi)(yi)療服(fu)務設(she)施的(de)范圍和(he)給付標(biao)準。

在(zai)選擇基(ji)本(ben)醫(yi)(yi)療(liao)保險(xian)藥品和診療(liao)項目(mu)的(de)(de)(de)(de)(de)具體方(fang)(fang)法(fa)上(shang)，國際最近流行用(yong)經濟學(xue)(xue)的(de)(de)(de)(de)(de)評價(jia)(jia)方(fang)(fang)法(fa)，綜合考慮和比較藥品或治療(liao)技術的(de)(de)(de)(de)(de)成(cheng)(cheng)(cheng)本(ben)效果。比如，甲(jia)(jia)(jia)藥單(dan)價(jia)(jia)很(hen)貴，但(dan)很(hen)快就能見(jian)效，病人不久就能康復、上(shang)班；乙(yi)藥單(dan)價(jia)(jia)很(hen)便(bian)宜，卻(que)在(zai)較長時間(jian)的(de)(de)(de)(de)(de)服用(yong)后有(you)效，自己工作受影(ying)響。如果僅僅看(kan)單(dan)價(jia)(jia)成(cheng)(cheng)(cheng)本(ben)，乙(yi)藥看(kan)起(qi)來屬于“基(ji)本(ben)醫(yi)(yi)療(liao)”，但(dan)在(zai)對(dui)甲(jia)(jia)(jia)、乙(yi)兩種藥物的(de)(de)(de)(de)(de)成(cheng)(cheng)(cheng)本(ben)效果進行認真、細致(zhi)的(de)(de)(de)(de)(de)比較之后，甲(jia)(jia)(jia)藥就可(ke)能進入基(ji)本(ben)醫(yi)(yi)療(liao)保險(xian)的(de)(de)(de)(de)(de)報銷范圍(wei)。所以(yi)(yi)，基(ji)本(ben)醫(yi)(yi)療(liao)保險(xian)的(de)(de)(de)(de)(de)界(jie)(jie)定是(shi)醫(yi)(yi)療(liao)技術問題，但(dan)更(geng)是(shi)經濟學(xue)(xue)上(shang)的(de)(de)(de)(de)(de)問題，可(ke)以(yi)(yi)預計，成(cheng)(cheng)(cheng)本(ben)效果的(de)(de)(de)(de)(de)評價(jia)(jia)方(fang)(fang)法(fa)和思想(xiang)理念將(jiang)影(ying)響未來基(ji)本(ben)醫(yi)(yi)療(liao)的(de)(de)(de)(de)(de)界(jie)(jie)定和選擇。

2.實行(xing)基(ji)(ji)(ji)本醫(yi)(yi)療(liao)(liao)(liao)保險(xian)(xian)“板塊(kuai)式”的(de)(de)統(tong)帳(zhang)結(jie)合方式。即個(ge)人(ren)帳(zhang)戶和統(tong)籌(chou)基(ji)(ji)(ji)金(jin)之(zhi)間割(ge)斷關系(xi)，實行(xing)獨立分(fen)別運作，分(fen)別核算(suan)，風險(xian)(xian)各自(zi)負責(ze)。個(ge)人(ren)帳(zhang)戶管(guan)小(xiao)病(bing)(bing)(bing)，主(zhu)要用(yong)(yong)(yong)于(yu)門診醫(yi)(yi)療(liao)(liao)(liao)服(fu)(fu)(fu)務和統(tong)籌(chou)基(ji)(ji)(ji)金(jin)起(qi)付(fu)標準以下(xia)的(de)(de)住院醫(yi)(yi)療(liao)(liao)(liao)服(fu)(fu)(fu)務，個(ge)人(ren)帳(zhang)戶用(yong)(yong)(yong)完(wan)后(hou)，全部自(zi)負。統(tong)籌(chou)基(ji)(ji)(ji)金(jin)管(guan)大(da)(da)(da)病(bing)(bing)(bing)，主(zhu)要用(yong)(yong)(yong)于(yu)起(qi)付(fu)標準與(yu)最高支(zhi)付(fu)限額之(zhi)間的(de)(de)住院和門急診大(da)(da)(da)病(bing)(bing)(bing)醫(yi)(yi)療(liao)(liao)(liao)服(fu)(fu)(fu)務，個(ge)人(ren)也要負擔一定比例。“板塊(kuai)式”帳(zhang)戶運作方式首先(xian)在小(xiao)病(bing)(bing)(bing)上設立個(ge)人(ren)帳(zhang)戶，加(jia)強(qiang)了(le)個(ge)人(ren)對小(xiao)病(bing)(bing)(bing)的(de)(de)自(zi)我保障責(ze)任；其次，由于(yu)次數頻、難控制的(de)(de)小(xiao)病(bing)(bing)(bing)費用(yong)(yong)(yong)進不了(le)統(tong)籌(chou)基(ji)(ji)(ji)金(jin)，減少了(le)統(tong)籌(chou)基(ji)(ji)(ji)金(jin)透支(zhi)的(de)(de)可能性，統(tong)籌(chou)基(ji)(ji)(ji)金(jin)集中解決(jue)大(da)(da)(da)病(bing)(bing)(bing)，加(jia)強(qiang)了(le)抵抗(kang)大(da)(da)(da)病(bing)(bing)(bing)風險(xian)(xian)的(de)(de)能力；再次，大(da)(da)(da)病(bing)(bing)(bing)的(de)(de)醫(yi)(yi)療(liao)(liao)(liao)服(fu)(fu)(fu)務、藥品消費具有較(jiao)強(qiang)的(de)(de)“資產專用(yong)(yong)(yong)性“，醫(yi)(yi)療(liao)(liao)(liao)保險(xian)(xian)管(guan)理(li)(li)機構(gou)把管(guan)理(li)(li)的(de)(de)重點放在費用(yong)(yong)(yong)高又較(jiao)易監控的(de)(de)大(da)(da)(da)病(bing)(bing)(bing)部分(fen)，集中力量抓主(zhu)要問題，有利(li)于(yu)提高統(tong)籌(chou)基(ji)(ji)(ji)金(jin)的(de)(de)管(guan)理(li)(li)效果。

對(dui)于超過(guo)最高支付限額(e)(e)的醫(yi)療(liao)費(fei)用，已不再屬于基本醫(yi)療(liao)保(bao)(bao)險(xian)的范(fan)疇，應(ying)通過(guo)補(bu)充(chong)醫(yi)療(liao)保(bao)(bao)險(xian)、商業醫(yi)療(liao)保(bao)(bao)險(xian)或社(she)會(hui)醫(yi)療(liao)救助等途徑(jing)解決。基本醫(yi)療(liao)保(bao)(bao)險(xian)的封(feng)頂(ding)額(e)(e)應(ying)是“超大病”補(bu)充(chong)醫(yi)療(liao)保(bao)(bao)險(xian)的起付額(e)(e)，即超過(guo)基本醫(yi)療(liao)保(bao)(bao)險(xian)的封(feng)頂(ding)額(e)(e)后才進入“超大病”補(bu)充(chong)醫(yi)療(liao)保(bao)(bao)險(xian)。

3.選擇(ze)按(an)病(bing)(bing)(bing)種付費的(de)(de)(de)(de)結(jie)算(suan)辦法(fa)。目前國內普遍采用(yong)(yong)的(de)(de)(de)(de)醫(yi)(yi)(yi)療(liao)(liao)服(fu)務(wu)機(ji)(ji)(ji)構與醫(yi)(yi)(yi)療(liao)(liao)保險機(ji)(ji)(ji)構之間“按(an)服(fu)務(wu)收(shou)費”的(de)(de)(de)(de)償(chang)(chang)付方式(shi)(shi)，在(zai)(zai)客觀上促使醫(yi)(yi)(yi)療(liao)(liao)機(ji)(ji)(ji)構以過度使用(yong)(yong)醫(yi)(yi)(yi)療(liao)(liao)資(zi)源(yuan)的(de)(de)(de)(de)方式(shi)(shi)，而不是以最有效(xiao)的(de)(de)(de)(de)方式(shi)(shi)提(ti)供(gong)(gong)服(fu)務(wu)。“按(an)病(bing)(bing)(bing)種付費”是根據每一(yi)種疾病(bing)(bing)(bing)或病(bing)(bing)(bing)程(cheng)所需(xu)全部服(fu)務(wu)進行事先定價(jia)后，按(an)此(ci)標(biao)準支付給(gei)醫(yi)(yi)(yi)療(liao)(liao)服(fu)務(wu)提(ti)供(gong)(gong)者。美(mei)國的(de)(de)(de)(de)預付制和德國的(de)(de)(de)(de)按(an)點數付費，在(zai)(zai)本質上都(dou)屬于(yu)“按(an)病(bing)(bing)(bing)種付費”方式(shi)(shi)。隨著醫(yi)(yi)(yi)療(liao)(liao)技(ji)術的(de)(de)(de)(de)發展(zhan)，對同一(yi)疾病(bing)(bing)(bing)的(de)(de)(de)(de)治(zhi)(zhi)療(liao)(liao)有了越(yue)來越(yue)多(duo)的(de)(de)(de)(de)治(zhi)(zhi)療(liao)(liao)方案(an)(an)，其費用(yong)(yong)的(de)(de)(de)(de)差別也越(yue)來越(yue)大(da)。醫(yi)(yi)(yi)療(liao)(liao)實踐(jian)的(de)(de)(de)(de)發展(zhan)迫(po)切需(xu)要通過技(ji)術經濟分析科學測算(suan)每一(yi)病(bing)(bing)(bing)種的(de)(de)(de)(de)標(biao)準化(hua)(hua)診斷、標(biao)準化(hua)(hua)治(zhi)(zhi)療(liao)(liao)、標(biao)準化(hua)(hua)藥品的(de)(de)(de)(de)費用(yong)(yong)，在(zai)(zai)眾多(duo)的(de)(de)(de)(de)治(zhi)(zhi)療(liao)(liao)方案(an)(an)中(zhong)，選擇(ze)適(shi)當的(de)(de)(de)(de)治(zhi)(zhi)療(liao)(liao)方案(an)(an)，并作為醫(yi)(yi)(yi)保機(ji)(ji)(ji)構費用(yong)(yong)償(chang)(chang)付的(de)(de)(de)(de)依據。“按(an)病(bing)(bing)(bing)種付費”方式(shi)(shi)，可有效(xiao)地限制醫(yi)(yi)(yi)生在(zai)(zai)決策中(zhong)的(de)(de)(de)(de)“獨(du)斷專(zhuan)行”，避(bi)免提(ti)供(gong)(gong)過度服(fu)務(wu)。

四、建立政事分開的(de)醫(yi)療保險管(guan)理體制

政府(fu)行政主管(guan)部門(men)(men)負(fu)責(ze)統(tong)一制定醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)法(fa)規和(he)(he)政策，建(jian)立(li)基本(ben)醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)的(de)(de)運作框架，規范和(he)(he)監督醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)經辦機(ji)構、用人單位、個人、醫(yi)(yi)(yi)院、制藥、金(jin)融(rong)等(deng)相(xiang)關(guan)(guan)利益群(qun)體的(de)(de)行為，確(que)定補充醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)和(he)(he)商業(ye)醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)的(de)(de)有關(guan)(guan)照顧(gu)扶持(chi)政策。這(zhe)里(li)需要(yao)特別提(ti)出的(de)(de)是，基本(ben)醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)劃(hua)歸衛(wei)(wei)生(sheng)(sheng)部主管(guan)比(bi)歸屬勞動和(he)(he)社(she)會(hui)(hui)(hui)保(bao)(bao)(bao)(bao)(bao)障部管(guan)理(li)(li)(li)更為合(he)理(li)(li)(li)。由(you)于(yu)(yu)(yu)醫(yi)(yi)(yi)療(liao)(liao)(liao)資(zi)源(yuan)的(de)(de)使用效益和(he)(he)需求(qiu)總量的(de)(de)控制與醫(yi)(yi)(yi)療(liao)(liao)(liao)服(fu)(fu)(fu)務(wu)(wu)的(de)(de)供(gong)方(fang)（醫(yi)(yi)(yi)院和(he)(he)醫(yi)(yi)(yi)生(sheng)(sheng)）密(mi)切(qie)相(xiang)關(guan)(guan)，這(zhe)就要(yao)求(qiu)醫(yi)(yi)(yi)療(liao)(liao)(liao)服(fu)(fu)(fu)務(wu)(wu)部門(men)(men)和(he)(he)基金(jin)管(guan)理(li)(li)(li)部門(men)(men)在同一個部門(men)(men)的(de)(de)領導下，相(xiang)配(pei)合(he)而不結合(he)。因此，社(she)會(hui)(hui)(hui)醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)劃(hua)歸衛(wei)(wei)生(sheng)(sheng)部管(guan)理(li)(li)(li)是比(bi)較合(he)理(li)(li)(li)的(de)(de)；將有利于(yu)(yu)(yu)衛(wei)(wei)生(sheng)(sheng)部門(men)(men)實(shi)行行業(ye)管(guan)理(li)(li)(li)、統(tong)籌規劃(hua)、充分利用有限的(de)(de)衛(wei)(wei)生(sheng)(sheng)資(zi)源(yuan)，有利于(yu)(yu)(yu)逐(zhu)步(bu)形成政府(fu)衛(wei)(wei)生(sheng)(sheng)部門(men)(men)指(zhi)導下的(de)(de)醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)方(fang)和(he)(he)醫(yi)(yi)(yi)療(liao)(liao)(liao)服(fu)(fu)(fu)務(wu)(wu)提(ti)供(gong)方(fang)雙(shuang)方(fang)買賣的(de)(de)格局，促進現代醫(yi)(yi)(yi)療(liao)(liao)(liao)市場(chang)的(de)(de)發(fa)育和(he)(he)完善，有利于(yu)(yu)(yu)擴大醫(yi)(yi)(yi)療(liao)(liao)(liao)服(fu)(fu)(fu)務(wu)(wu)范圍，將預防、保(bao)(bao)(bao)(bao)(bao)健與治療(liao)(liao)(liao)以及社(she)區服(fu)(fu)(fu)務(wu)(wu)、醫(yi)(yi)(yi)院服(fu)(fu)(fu)務(wu)(wu)有機(ji)結合(he)，為最終實(shi)現全(quan)社(she)會(hui)(hui)(hui)醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)和(he)(he)人人平(ping)等(deng)享受醫(yi)(yi)(yi)療(liao)(liao)(liao)服(fu)(fu)(fu)務(wu)(wu)奠定組織(zhi)基礎(chu)和(he)(he)管(guan)理(li)(li)(li)基礎(chu)。國際社(she)會(hui)(hui)(hui)醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)制度(du)(du)管(guan)理(li)(li)(li)體制也朝(chao)著衛(wei)(wei)生(sheng)(sheng)部主管(guan)的(de)(de)模式發(fa)展(zhan)，并(bing)被越來越多的(de)(de)國家采用，尤(you)其(qi)是新建(jian)社(she)會(hui)(hui)(hui)醫(yi)(yi)(yi)療(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)險(xian)制度(du)(du)的(de)(de)國家。

篇6

關鍵詞 企業補充(chong)養老保(bao)險 企業年金 補充(chong)醫療保(bao)險政策 彈利(li)制度

一、企業參(can)保現狀(zhuang)和所存在的問題

作者所在的企業(ye)目前依法(fa)為(wei)(wei)全員(yuan)繳(jiao)(jiao)納(na)(na)社(she)(she)(she)(she)會(hui)保(bao)(bao)險(xian)(xian)(xian)費，五項社(she)(she)(she)(she)會(hui)保(bao)(bao)險(xian)(xian)(xian)：養(yang)老(lao)、醫療、失業(ye)、工傷(shang)、生(sheng)育保(bao)(bao)險(xian)(xian)(xian)覆蓋率(lv)達到100%。在企業(ye)保(bao)(bao)險(xian)(xian)(xian)制度(du)(du)方面一(yi)直以國家及(ji)天津市的社(she)(she)(she)(she)會(hui)保(bao)(bao)險(xian)(xian)(xian)征繳(jiao)(jiao)管(guan)理(li)辦法(fa)為(wei)(wei)藍本(ben)，嚴(yan)格遵守有關(guan)規定，依法(fa)繳(jiao)(jiao)納(na)(na)社(she)(she)(she)(she)會(hui)保(bao)(bao)險(xian)(xian)(xian)費。社(she)(she)(she)(she)會(hui)保(bao)(bao)險(xian)(xian)(xian)繳(jiao)(jiao)納(na)(na)一(yi)直作為(wei)(wei)我們企業(ye)管(guan)理(li)的高壓線，在嚴(yan)格按(an)照標準執行的基(ji)礎上(shang)(shang)，充分考(kao)慮員(yuan)工及(ji)全體社(she)(she)(she)(she)會(hui)成員(yuan)的公共利(li)益，在社(she)(she)(she)(she)保(bao)(bao)繳(jiao)(jiao)費基(ji)數確定過程中(zhong)，將(jiang)個(ge)人全年工資性收入(ru)全部納(na)(na)入(ru)其中(zhong)，盡(jin)量(liang)提高員(yuan)工養(yang)老(lao)保(bao)(bao)險(xian)(xian)(xian)和(he)醫療保(bao)(bao)險(xian)(xian)(xian)待(dai)遇。這一(yi)做法(fa)是企業(ye)社(she)(she)(she)(she)會(hui)保(bao)(bao)險(xian)(xian)(xian)管(guan)理(li)規章制度(du)(du)的原則，從制度(du)(du)上(shang)(shang)引(yin)導員(yuan)工正(zheng)確合理(li)看待(dai)個(ge)人職業(ye)生(sheng)涯過程中(zhong)的總體薪(xin)酬問題，長(chang)遠考(kao)慮個(ge)人退休養(yang)老(lao)問題，最(zui)大(da)程度(du)(du)上(shang)(shang)為(wei)(wei)個(ge)人儲(chu)備養(yang)老(lao)金。

但目(mu)前的(de)(de)(de)(de)問題是，由于國家管理(li)政策的(de)(de)(de)(de)整體要求和(he)養老(lao)保險所開(kai)始的(de)(de)(de)(de)時間，造(zao)成絕大部分(fen)員(yuan)工退休后養老(lao)金(jin)水平和(he)在職時工資相比差距(ju)較大，難(nan)以順利地完成過渡，造(zao)成員(yuan)工退出(chu)工作崗位后由于收入(ru)差距(ju)造(zao)成的(de)(de)(de)(de)心情壓(ya)抑和(he)生活(huo)質量的(de)(de)(de)(de)下降，從企業社會責任角度來講這是一個亟(ji)待解(jie)決的(de)(de)(de)(de)問題。

自(zi)實行基本醫療(liao)保(bao)險制度以來(lai)，員工(gong)看(kan)病(bing)所產生的醫藥(yao)費就(jiu)(jiu)實行了(le)社(she)會化管理(li)，同(tong)時由于(yu)(yu)社(she)會醫療(liao)事業(ye)整體調整，職(zhi)工(gong)不斷反映看(kan)病(bing)貴、看(kan)病(bing)難的問(wen)題，我(wo)們通過分析可(ke)以看(kan)出：職(zhi)工(gong)個(ge)人(ren)就(jiu)(jiu)醫負擔(dan)在急(ji)劇(ju)增(zeng)(zeng)加(jia)。醫療(liao)保(bao)險統(tong)籌基金支出雖然也在增(zeng)(zeng)加(jia)，但(dan)增(zeng)(zeng)幅(fu)遠小于(yu)(yu)個(ge)人(ren)賬戶(hu)支出增(zeng)(zeng)幅(fu)。職(zhi)工(gong)反映看(kan)病(bing)貴、看(kan)病(bing)難問(wen)題是真實和客(ke)觀存在的。對(dui)(dui)于(yu)(yu)一些(xie)有特殊大病(bing)的員工(gong)來(lai)講企(qi)業(ye)負擔(dan)的確減少(shao)，但(dan)員工(gong)負擔(dan)急(ji)劇(ju)加(jia)大，甚至使某些(xie)員工(gong)對(dui)(dui)生活失去(qu)(qu)信心，對(dui)(dui)未來(lai)失去(qu)(qu)信心，在一定程(cheng)度上影響著企(qi)業(ye)和社(she)會的公平、正義、穩定、和諧。

二(er)、分析相關問題并提出解決思路(lu)

筆者所在的企業采用了補充養(yang)老保(bao)險（企業年金(jin)計劃(hua)）、補充醫療(liao)保(bao)險和彈利制度，它的重大突破在于深深地印(yin)證了以人為本(ben)的現代管理(li)理(li)念(nian)，讓員工擁有(you)了主動權，尊重了員工自我需(xu)要的價值。

企(qi)(qi)業(ye)(ye)補(bu)(bu)充(chong)(chong)養老保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)、企(qi)(qi)業(ye)(ye)補(bu)(bu)充(chong)(chong)醫療保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)、彈利制度(du)勢在必(bi)行，針對企(qi)(qi)業(ye)(ye)參(can)保(bao)(bao)(bao)(bao)職工的(de)問題，適時調整企(qi)(qi)業(ye)(ye)補(bu)(bu)充(chong)(chong)養老保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)、醫療保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)政策(ce)及福利政策(ce)，充(chong)(chong)分利用(yong)基(ji)本社會保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)與企(qi)(qi)業(ye)(ye)補(bu)(bu)充(chong)(chong)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)政策(ce)的(de)互補(bu)(bu)性(xing)，依靠企(qi)(qi)業(ye)(ye)補(bu)(bu)充(chong)(chong)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)的(de)強大(da)保(bao)(bao)(bao)(bao)障作(zuo)用(yong)，積(ji)極努力解決參(can)保(bao)(bao)(bao)(bao)職工的(de)后顧之(zhi)憂，緩(huan)解參(can)保(bao)(bao)(bao)(bao)職工的(de)養老、就(jiu)醫壓力，有(you)效拉動保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)統籌(chou)基(ji)金(jin)支出，盤活(huo)保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)統籌(chou)基(ji)金(jin)，促進企(qi)(qi)業(ye)(ye)職工隊伍穩(wen)定，體現企(qi)(qi)業(ye)(ye)補(bu)(bu)充(chong)(chong)養老保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)、補(bu)(bu)充(chong)(chong)醫療保(bao)(bao)(bao)(bao)險(xian)(xian)(xian)(xian)、彈利制度(du)的(de)重要(yao)作(zuo)用(yong)。

三、企(qi)業(ye)補充養老保險的建立

企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)充(chong)養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)是(shi)(shi)企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)為(wei)職工(gong)建(jian)(jian)立的(de)旨在(zai)補(bu)(bu)(bu)充(chong)基(ji)(ji)(ji)本養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)不足的(de)一(yi)種(zhong)養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)形式。企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)按規(gui)定(ding)繳(jiao)(jiao)納基(ji)(ji)(ji)本養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)費(fei)后(hou)，在(zai)國(guo)家政策指(zhi)(zhi)導下，根據(ju)本單位經濟效益情況，為(wei)職工(gong)建(jian)(jian)立補(bu)(bu)(bu)充(chong)養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)并(bing)為(wei)員(yuan)工(gong)建(jian)(jian)立企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)年(nian)(nian)(nian)金(jin)保(bao)(bao)(bao)障。企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)補(bu)(bu)(bu)充(chong)養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)采用年(nian)(nian)(nian)金(jin)制(zhi)。企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)年(nian)(nian)(nian)金(jin)指(zhi)(zhi)由(you)政府提(ti)供(gong)(gong)優惠政策，實(shi)行勞動權利(li)與義務(wu)相(xiang)結合的(de)原則，由(you)企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)為(wei)主，個(ge)人為(wei)輔供(gong)(gong)款，實(shi)行積累制(zhi)籌(chou)資方(fang)式。對(dui)象為(wei)企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)職工(gong)，執行保(bao)(bao)(bao)障和(he)儲蓄(xu)功能。實(shi)行激勵(li)機(ji)制(zhi)，保(bao)(bao)(bao)證繳(jiao)(jiao)費(fei)者退休(xiu)后(hou)有更(geng)高的(de)生活水平和(he)更(geng)為(wei)充(chong)分的(de)保(bao)(bao)(bao)障。目(mu)前較為(wei)普遍的(de)補(bu)(bu)(bu)充(chong)養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)操作(zuo)(zuo)方(fang)式一(yi)般為(wei)：企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)以員(yuan)工(gong)所(suo)確定(ding)的(de)當年(nian)(nian)(nian)基(ji)(ji)(ji)本養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)繳(jiao)(jiao)費(fei)基(ji)(ji)(ji)數為(wei)基(ji)(ji)(ji)礎，確定(ding)一(yi)個(ge)全員(yuan)的(de)繳(jiao)(jiao)費(fei)比例，由(you)此計算每位員(yuan)工(gong)全年(nian)(nian)(nian)應得的(de)企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)年(nian)(nian)(nian)金(jin)，即(ji)補(bu)(bu)(bu)充(chong)養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)。這種(zhong)做(zuo)法(fa)實(shi)際上將補(bu)(bu)(bu)充(chong)養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)作(zuo)(zuo)為(wei)了(le)一(yi)種(zhong)基(ji)(ji)(ji)礎福利(li)，與全年(nian)(nian)(nian)工(gong)資性收入和(he)基(ji)(ji)(ji)本養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)費(fei)的(de)繳(jiao)(jiao)納完全相(xiang)關。筆者所(suo)在(zai)的(de)企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)在(zai)補(bu)(bu)(bu)充(chong)養(yang)(yang)(yang)老(lao)(lao)(lao)保(bao)(bao)(bao)險(xian)(xian)的(de)操作(zuo)(zuo)上更(geng)多體(ti)現了(le)激勵(li)機(ji)制(zhi)，以年(nian)(nian)(nian)度績(ji)效考(kao)核結果為(wei)基(ji)(ji)(ji)礎確定(ding)員(yuan)工(gong)獎勵(li)梯次，每個(ge)梯次人員(yuan)獲得相(xiang)應比例獎勵(li)，金(jin)額注入個(ge)人企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)年(nian)(nian)(nian)金(jin)計劃賬戶。這種(zhong)做(zuo)法(fa)相(xiang)對(dui)公平一(yi)些，可以使(shi)考(kao)核優秀的(de)普通員(yuan)工(gong)獲得更(geng)多收入，拉小企(qi)(qi)(qi)業(ye)(ye)(ye)(ye)(ye)(ye)(ye)內部貧富(fu)差距。但是(shi)(shi)也(ye)存(cun)在(zai)弊端就是(shi)(shi)績(ji)效評(ping)價的(de)公正(zheng)性。

筆者所在的(de)(de)企業(ye)采取的(de)(de)是對(dui)外(wai)投(tou)保(bao)，這(zhe)種(zhong)方式下(xia)企業(ye)養(yang)老(lao)金的(de)(de)支(zhi)付風險轉(zhuan)移到了(le)保(bao)險公(gong)司，因而它(ta)可(ke)以克服“直接承(cheng)保(bao)”方式下(xia)沒有第三(san)方承(cheng)擔支(zhi)付風險的(de)(de)缺(que)點。在對(dui)外(wai)投(tou)保(bao)方式下(xia)，企業(ye)和職工向(xiang)保(bao)險公(gong)司繳納保(bao)費。

四、企業補充醫療保險的(de)特點

筆者(zhe)(zhe)所在(zai)(zai)(zai)的(de)(de)(de)(de)(de)企(qi)業(ye)(ye)實施(shi)的(de)(de)(de)(de)(de)企(qi)業(ye)(ye)補(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險政(zheng)策有如(ru)下特(te)點(dian)：首(shou)先是(shi)(shi)(shi)(shi)進入企(qi)業(ye)(ye)補(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險的(de)(de)(de)(de)(de)門(men)檻(jian)低，沒有起付(fu)限(xian)(xian)制，規定在(zai)(zai)(zai)一個(ge)(ge)自(zi)(zi)然年度內，參(can)保(bao)(bao)(bao)職(zhi)工只要(yao)在(zai)(zai)(zai)定點(dian)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)機構就醫(yi)(yi)(yi)(yi)(yi)(yi)，不(bu)論是(shi)(shi)(shi)(shi)符(fu)合醫(yi)(yi)(yi)(yi)(yi)(yi)限(xian)(xian)報(bao)銷(xiao)的(de)(de)(de)(de)(de)支(zhi)(zhi)出還(huan)是(shi)(shi)(shi)(shi)自(zi)(zi)付(fu)費(fei)部分，均給予(yu)企(qi)業(ye)(ye)職(zhi)工補(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險補(bu)(bu)(bu)助(zhu)(zhu)(zhu)。其(qi)次(ci)是(shi)(shi)(shi)(shi)自(zi)(zi)付(fu)統計范圍大(da)，包括職(zhi)工全年普(pu)通問診、慢性病門(men)診和(he)住(zhu)院所產(chan)生的(de)(de)(de)(de)(de)符(fu)合基本醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險的(de)(de)(de)(de)(de)自(zi)(zi)負費(fei)用。第三是(shi)(shi)(shi)(shi)補(bu)(bu)(bu)助(zhu)(zhu)(zhu)金(jin)(jin)(jin)額高(gao)，符(fu)合基本醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險的(de)(de)(de)(de)(de)自(zi)(zi)付(fu)費(fei)用最高(gao)補(bu)(bu)(bu)助(zhu)(zhu)(zhu)10萬元(yuan)，并對當年統籌累計超過(guo)20萬元(yuan)者(zhe)(zhe)給予(yu)超大(da)額企(qi)補(bu)(bu)(bu)。最后是(shi)(shi)(shi)(shi)補(bu)(bu)(bu)助(zhu)(zhu)(zhu)比例(li)大(da)，補(bu)(bu)(bu)助(zhu)(zhu)(zhu)采取分段(duan)補(bu)(bu)(bu)助(zhu)(zhu)(zhu)，自(zi)(zi)付(fu)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)費(fei)累計在(zai)(zai)(zai)0～50000元(yuan)，補(bu)(bu)(bu)助(zhu)(zhu)(zhu)50%；自(zi)(zi)付(fu)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)費(fei)累計在(zai)(zai)(zai)50001～100000元(yuan)，補(bu)(bu)(bu)助(zhu)(zhu)(zhu)60%；自(zi)(zi)付(fu)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)費(fei)累計在(zai)(zai)(zai)100000元(yuan)以(yi)上(shang)，補(bu)(bu)(bu)助(zhu)(zhu)(zhu)70%。針對企(qi)業(ye)(ye)部分員工的(de)(de)(de)(de)(de)特(te)殊情(qing)況(kuang)，單位特(te)設置了愛心救(jiu)助(zhu)(zhu)(zhu)基金(jin)(jin)(jin)，專(zhuan)門(men)幫助(zhu)(zhu)(zhu)患有大(da)病的(de)(de)(de)(de)(de)員工，支(zhi)(zhi)付(fu)標(biao)準(zhun)沒有上(shang)限(xian)(xian)。企(qi)業(ye)(ye)職(zhi)工補(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險是(shi)(shi)(shi)(shi)建立(li)多層次(ci)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)體系的(de)(de)(de)(de)(de)一個(ge)(ge)重要(yao)方面，是(shi)(shi)(shi)(shi)在(zai)(zai)(zai)城鎮(zhen)職(zhi)工基本醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險基礎上(shang)建立(li)的(de)(de)(de)(de)(de)一種補(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)形(xing)式。通過(guo)對企(qi)業(ye)(ye)補(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險政(zheng)策的(de)(de)(de)(de)(de)不(bu)斷修改，降(jiang)低門(men)檻(jian)，提高(gao)補(bu)(bu)(bu)助(zhu)(zhu)(zhu)比例(li)，使享受(shou)企(qi)業(ye)(ye)補(bu)(bu)(bu)充(chong)(chong)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險的(de)(de)(de)(de)(de)人數和(he)補(bu)(bu)(bu)助(zhu)(zhu)(zhu)金(jin)(jin)(jin)額呈現跨越式地增長，職(zhi)工得到企(qi)業(ye)(ye)醫(yi)(yi)(yi)(yi)(yi)(yi)療(liao)補(bu)(bu)(bu)助(zhu)(zhu)(zhu)的(de)(de)(de)(de)(de)實惠。

五、試行彈利制度

彈(dan)利(li)制(zhi)(zhi)度(du)，又稱為(wei)自(zi)(zi)助餐(can)式的(de)(de)(de)福(fu)(fu)(fu)(fu)利(li)制(zhi)(zhi)度(du)，指在固定的(de)(de)(de)福(fu)(fu)(fu)(fu)利(li)費用(yong)預算內，企(qi)業(ye)針對(dui)不(bu)同層次員工(gong)的(de)(de)(de)個(ge)(ge)性(xing)化(hua)福(fu)(fu)(fu)(fu)利(li)保障需(xu)求，有(you)針對(dui)性(xing)地(di)設計(ji)和實施多(duo)樣化(hua)的(de)(de)(de)福(fu)(fu)(fu)(fu)利(li)項(xiang)(xiang)目供員工(gong)選擇(ze)，使每個(ge)(ge)員工(gong)的(de)(de)(de)福(fu)(fu)(fu)(fu)利(li)保障需(xu)求得(de)到最大滿足的(de)(de)(de)福(fu)(fu)(fu)(fu)利(li)項(xiang)(xiang)目組合。簡(jian)而(er)言之，就是(shi)員工(gong)從企(qi)業(ye)提(ti)供的(de)(de)(de)一份列有(you)各種福(fu)(fu)(fu)(fu)利(li)項(xiang)(xiang)目的(de)(de)(de)“菜單”中選擇(ze)其所需(xu)要(yao)的(de)(de)(de)福(fu)(fu)(fu)(fu)利(li)項(xiang)(xiang)目，還包括工(gong)作(zuo)條件彈(dan)性(xing)化(hua)。每位職工(gong)都可(ke)(ke)以(yi)選擇(ze)適合自(zi)(zi)己的(de)(de)(de)福(fu)(fu)(fu)(fu)利(li)項(xiang)(xiang)目，每個(ge)(ge)福(fu)(fu)(fu)(fu)利(li)項(xiang)(xiang)目一一定價，職工(gong)可(ke)(ke)以(yi)根據企(qi)業(ye)福(fu)(fu)(fu)(fu)利(li)規(gui)定，結合自(zi)(zi)己能(neng)夠享受的(de)(de)(de)福(fu)(fu)(fu)(fu)利(li)總額(e)自(zi)(zi)由選擇(ze)所需(xu)要(yao)的(de)(de)(de)福(fu)(fu)(fu)(fu)利(li)項(xiang)(xiang)目。

彈利(li)(li)(li)制度政策需(xu)隨(sui)時調(diao)整，為(wei)了達到隨(sui)時為(wei)每(mei)位員(yuan)工(gong)(gong)提供(gong)有(you)(you)吸引(yin)力福利(li)(li)(li)的(de)目標(biao)，需(xu)要(yao)不(bu)斷(duan)調(diao)整企業(ye)的(de)福利(li)(li)(li)政策以適應(ying)環境(jing)條件的(de)變(bian)化。我(wo)們(men)首先診(zhen)(zhen)斷(duan)福利(li)(li)(li)體系(xi)是(shi)否需(xu)要(yao)改變(bian)，要(yao)看福利(li)(li)(li)制度總(zong)體的(de)狀況是(shi)否有(you)(you)效(xiao)。其次，在(zai)這個基礎之上對一些福利(li)(li)(li)項目做出(chu)評(ping)價，對核心福利(li)(li)(li)應(ying)定(ding)期評(ping)審一次以保持其有(you)(you)效(xiao)性。第(di)三，我(wo)們(men)還需(xu)要(yao)診(zhen)(zhen)斷(duan)員(yuan)工(gong)(gong)對現有(you)(you)水平的(de)滿意度。因為(wei)員(yuan)工(gong)(gong)的(de)積極性與其期望有(you)(you)很大的(de)關聯，如果與外界的(de)福利(li)(li)(li)無法(fa)獲得平衡，必然(ran)引(yin)起員(yuan)工(gong)(gong)的(de)不(bu)滿和失望，從而導致勞動生(sheng)產(chan)率的(de)下降(jiang)。所(suo)以應(ying)該(gai)定(ding)期將本企業(ye)的(de)福利(li)(li)(li)政策進行(xing)合(he)理調(diao)整。

六、結語

篇7

隨(sui)著國家信息化的(de)(de)高速進展(zhan)，復雜(za)信息系(xi)(xi)統(tong)逐漸占(zhan)據了(le)市場(chang)的(de)(de)主(zhu)流，由于信息系(xi)(xi)統(tong)的(de)(de)復雜(za)化，傳統(tong)的(de)(de)軟(ruan)件需(xu)求分(fen)析不能很(hen)好(hao)地對(dui)復雜(za)信息系(xi)(xi)統(tong)進行(xing)管(guan)理(li)(li)，需(xu)求工程(cheng)(cheng)的(de)(de)概念應運而生(sheng)。需(xu)求工程(cheng)(cheng)是隨(sui)著計(ji)算機(ji)的(de)(de)發展(zhan)而發展(zhan)的(de)(de)，隨(sui)著軟(ruan)件系(xi)(xi)統(tong)規模(mo)的(de)(de)擴(kuo)大，需(xu)求工程(cheng)(cheng)與定義在整個軟(ruan)件開發與維(wei)護過(guo)程(cheng)(cheng)中越來越重(zhong)要，直接關系(xi)(xi)到軟(ruan)件的(de)(de)成功與否。本文(wen)主(zhu)要介紹了(le)軟(ruan)件需(xu)求的(de)(de)概念、內(nei)容，需(xu)求工程(cheng)(cheng)的(de)(de)概念、需(xu)求開發、需(xu)求管(guan)理(li)(li)以及需(xu)求工程(cheng)(cheng)各階段的(de)(de)具體(ti)實現，而且還以醫療保險管(guan)理(li)(li)信息系(xi)(xi)統(tong)項目為例，詳細說明了(le)網站(zhan)開發項目的(de)(de)需(xu)求實現過(guo)程(cheng)(cheng)。

關鍵詞：

信(xin)息系統；需求工程；需求管理

用(yong)戶定義的(de)“需(xu)(xu)(xu)求”對開(kai)發(fa)(fa)人員(yuan)來(lai)說(shuo)是(shi)一(yi)個(ge)較高層次的(de)產品概念，而開(kai)發(fa)(fa)人員(yuan)所說(shuo)的(de)“需(xu)(xu)(xu)求”對用(yong)戶來(lai)說(shuo)又(you)像是(shi)詳(xiang)細設計。對于軟件需(xu)(xu)(xu)求，可以從(cong)以下幾個(ge)觀(guan)點(dian)來(lai)看：從(cong)用(yong)戶角度(du)出(chu)發(fa)(fa)的(de)觀(guan)點(dian)指明從(cong)系統(tong)外(wai)部能(neng)夠發(fa)(fa)現(xian)(xian)系統(tong)具有的(de)滿足于用(yong)戶的(de)特(te)點(dian)、功能(neng)及屬(shu)性(xing)(xing)等(deng)。從(cong)開(kai)發(fa)(fa)人員(yuan)角度(du)出(chu)發(fa)(fa)的(de)觀(guan)點(dian)指明必須(xu)實現(xian)(xian)何種目的(de)的(de)規格說(shuo)明。他描述了系統(tong)的(de)行為、特(te)性(xing)(xing)或屬(shu)性(xing)(xing)，是(shi)在(zai)開(kai)發(fa)(fa)過程中(zhong)對系統(tong)的(de)約束(shu)。

綜合用戶和(he)開發(fa)人員雙方的觀點

1、用戶解決問(wen)題(ti)或達到目標(biao)(biao)所(suo)(suo)(suo)需(xu)的(de)(de)(de)(de)條(tiao)件(jian)或能(neng)力。2、系(xi)(xi)統(tong)或系(xi)(xi)統(tong)部件(jian)要滿(man)足合同、標(biao)(biao)準、規(gui)范或其(qi)他(ta)正式規(gui)定文(wen)檔所(suo)(suo)(suo)需(xu)具有的(de)(de)(de)(de)條(tiao)件(jian)或能(neng)力。3、一(yi)種反映(ying)上述(shu)所(suo)(suo)(suo)描述(shu)的(de)(de)(de)(de)條(tiao)件(jian)或能(neng)力的(de)(de)(de)(de)文(wen)檔說明。它強(qiang)調了不(bu)但(dan)需(xu)求(qiu)(qiu)中包(bao)含目標(biao)(biao)而且還(huan)要包(bao)含實(shi)(shi)(shi)(shi)現(xian)用戶目標(biao)(biao)所(suo)(suo)(suo)需(xu)要滿(man)足的(de)(de)(de)(de)條(tiao)件(jian)或能(neng)力，同時(shi)必(bi)(bi)須(xu)以規(gui)范文(wen)檔的(de)(de)(de)(de)形(xing)式表(biao)述(shu)。需(xu)求(qiu)(qiu)工(gong)程的(de)(de)(de)(de)概念：需(xu)求(qiu)(qiu)工(gong)程包(bao)括創建和(he)(he)維護系(xi)(xi)統(tong)需(xu)求(qiu)(qiu)文(wen)檔所(suo)(suo)(suo)必(bi)(bi)需(xu)的(de)(de)(de)(de)一(yi)切(qie)活(huo)動的(de)(de)(de)(de)過程，包(bao)括需(xu)求(qiu)(qiu)開發和(he)(he)需(xu)求(qiu)(qiu)管理(li)(li)兩大(da)工(gong)作。一(yi)個小的(de)(de)(de)(de)項目要做到需(xu)求(qiu)(qiu)過程的(de)(de)(de)(de)完全(quan)規(gui)范化(hua)，隨著(zhu)開發工(gong)作的(de)(de)(de)(de)進行(xing)和(he)(he)用戶需(xu)求(qiu)(qiu)的(de)(de)(de)(de)不(bu)斷變(bian)更(geng)，其(qi)工(gong)作量已(yi)經相當驚人(ren)。實(shi)(shi)(shi)(shi)例——醫(yi)(yi)療保險(xian)管理(li)(li)信息(xi)系(xi)(xi)統(tong)需(xu)求(qiu)(qiu)管理(li)(li)的(de)(de)(de)(de)實(shi)(shi)(shi)(shi)現(xian)。基本的(de)(de)(de)(de)醫(yi)(yi)療保險(xian)制(zhi)度(du)(du)是社(she)會保險(xian)制(zhi)度(du)(du)的(de)(de)(de)(de)重要組(zu)成部分(fen)，關系(xi)(xi)到百姓的(de)(de)(de)(de)切(qie)實(shi)(shi)(shi)(shi)利(li)益，而且涉及面(mian)廣、金額大(da)、業務量大(da)、政策性強(qiang)，因此，在實(shi)(shi)(shi)(shi)施管理(li)(li)系(xi)(xi)統(tong)時(shi)必(bi)(bi)須(xu)要可靠、高效(xiao)、穩(wen)妥，最好一(yi)步到位實(shi)(shi)(shi)(shi)現(xian)信息(xi)化(hua)管理(li)(li)。

一、業務需求

通過與(yu)(yu)(yu)(yu)客戶的反(fan)復溝通，以與(yu)(yu)(yu)(yu)客戶開座談會、與(yu)(yu)(yu)(yu)用戶進行(xing)訪談，與(yu)(yu)(yu)(yu)客戶的領導進行(xing)溝通，得到本(ben)醫(yi)療保(bao)(bao)(bao)(bao)(bao)險(xian)管理(li)信息系統所涉及(ji)到的基本(ben)業務有(you)：1、參(can)(can)保(bao)(bao)(bao)(bao)(bao)人(ren)員(yuan)社會保(bao)(bao)(bao)(bao)(bao)險(xian)基金(jin)的征繳；2、參(can)(can)保(bao)(bao)(bao)(bao)(bao)人(ren)員(yuan)醫(yi)療費用的審核、結(jie)算；3、參(can)(can)保(bao)(bao)(bao)(bao)(bao)人(ren)員(yuan)的自然(ran)狀況(kuang)，健康狀況(kuang)的動態(tai)記(ji)錄、修改及(ji)管理(li)；4、參(can)(can)保(bao)(bao)(bao)(bao)(bao)人(ren)員(yuan)30年(nian)有(you)關醫(yi)療保(bao)(bao)(bao)(bao)(bao)險(xian)信息的保(bao)(bao)(bao)(bao)(bao)存(cun)與(yu)(yu)(yu)(yu)管理(li)；5、參(can)(can)保(bao)(bao)(bao)(bao)(bao)人(ren)員(yuan)醫(yi)療保(bao)(bao)(bao)(bao)(bao)險(xian)卡制作、發行(xing)與(yu)(yu)(yu)(yu)管理(li)；6、經常大規模的信息查(cha)詢與(yu)(yu)(yu)(yu)統計；7、特別情況(kuang)的管理(li)及(ji)處理(li)。

二、功能需求

面對如此復雜的(de)(de)(de)系(xi)(xi)統(tong)(tong)，技術人(ren)(ren)(ren)員通(tong)過與(yu)(yu)客(ke)戶的(de)(de)(de)領導和(he)相關(guan)人(ren)(ren)(ren)員反(fan)復溝通(tong)，首先確定(ding)了一些技術要(yao)(yao)點和(he)優先要(yao)(yao)實(shi)現(xian)的(de)(de)(de)目標。也就是確定(ding)了本醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險(xian)(xian)(xian)管(guan)理(li)信(xin)(xin)(xin)息(xi)系(xi)(xi)統(tong)(tong)的(de)(de)(de)功能需求：1、通(tong)過醫(yi)(yi)(yi)保(bao)(bao)(bao)信(xin)(xin)(xin)息(xi)系(xi)(xi)統(tong)(tong)的(de)(de)(de)建設(she)，使客(ke)戶醫(yi)(yi)(yi)保(bao)(bao)(bao)工(gong)作(zuo)(zuo)從基(ji)金(jin)收繳、支(zhi)付(fu)到(dao)賬(zhang)務(wu)往來(lai)管(guan)理(li)、統(tong)(tong)計(ji)(ji)分析(xi)基(ji)本實(shi)現(xian)計(ji)(ji)算機(ji)化；2、將各經辦(ban)機(ji)構的(de)(de)(de)工(gong)作(zuo)(zuo)人(ren)(ren)(ren)員集中(zhong)在控(kong)制(zhi)中(zhong)心(xin)，開展業務(wu)工(gong)作(zuo)(zuo)，行使管(guan)理(li)職能；3、建立參保(bao)(bao)(bao)人(ren)(ren)(ren)口的(de)(de)(de)醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險(xian)(xian)(xian)個人(ren)(ren)(ren)信(xin)(xin)(xin)息(xi)數(shu)(shu)據庫(ku)，并將涵蓋其它險(xian)(xian)(xian)種所需的(de)(de)(de)基(ji)本信(xin)(xin)(xin)息(xi)；4、在醫(yi)(yi)(yi)療(liao)機(ji)構與(yu)(yu)醫(yi)(yi)(yi)保(bao)(bao)(bao)中(zhong)心(xin)之間通(tong)過數(shu)(shu)據接口實(shi)現(xian)計(ji)(ji)算機(ji)費(fei)用(yong)結算工(gong)作(zuo)(zuo)；5、在銀行與(yu)(yu)醫(yi)(yi)(yi)保(bao)(bao)(bao)中(zhong)心(xin)之間通(tong)過數(shu)(shu)據接口實(shi)現(xian)計(ji)(ji)算機(ji)自動轉(zhuan)賬(zhang)；6、通(tong)過與(yu)(yu)定(ding)點醫(yi)(yi)(yi)療(liao)機(ji)構、定(ding)點藥(yao)店等相關(guan)部門建立網絡(luo)連接，實(shi)現(xian)門診(zhen)處方的(de)(de)(de)計(ji)(ji)算機(ji)系(xi)(xi)統(tong)(tong)事(shi)前(qian)審核（PCS），改善醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險(xian)(xian)(xian)監控(kong)手段，為合(he)理(li)控(kong)制(zhi)醫(yi)(yi)(yi)療(liao)費(fei)用(yong)增(zeng)長，減少醫(yi)(yi)(yi)療(liao)資源浪費(fei)提供支(zhi)持(chi)，進而保(bao)(bao)(bao)障醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險(xian)(xian)(xian)基(ji)金(jin)高效(xiao)運行；7、通(tong)過業務(wu)數(shu)(shu)據，對基(ji)本醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險(xian)(xian)(xian)基(ji)金(jin)的(de)(de)(de)收入(ru)和(he)支(zhi)出進行動態監控(kong)和(he)分析(xi)預測，對政策執行情況(kuang)進行評估，達到(dao)決策科(ke)學化，進而保(bao)(bao)(bao)障醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險(xian)(xian)(xian)基(ji)金(jin)長期運行；8、并通(tong)過本次醫(yi)(yi)(yi)保(bao)(bao)(bao)信(xin)(xin)(xin)息(xi)系(xi)(xi)統(tong)(tong)的(de)(de)(de)建設(she)，為客(ke)戶社會(hui)保(bao)(bao)(bao)險(xian)(xian)(xian)信(xin)(xin)(xin)息(xi)系(xi)(xi)統(tong)(tong)（養老、醫(yi)(yi)(yi)療(liao)、工(gong)傷、生育、失(shi)業五險(xian)(xian)(xian)合(he)一）的(de)(de)(de)建設(she)作(zuo)(zuo)好(hao)準備(bei)。

三、涉及部門

為了(le)適應社(she)會(hui)(hui)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)障體(ti)系(xi)信息系(xi)統一(yi)體(ti)化建(jian)設的(de)(de)(de)(de)(de)需要(yao)(yao)(yao)，以(yi)及(ji)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)業務(wu)的(de)(de)(de)(de)(de)變化，還有醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)險(xian)(xian)(xian)種(zhong)的(de)(de)(de)(de)(de)擴充（如(ru)企(qi)業補(bu)充醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)、公務(wu)員醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)補(bu)助、大(da)額醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)費(fei)(fei)(fei)用(yong)(yong)互(hu)助保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)、商業醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)等(deng)），在(zai)(zai)數(shu)(shu)據(ju)結(jie)(jie)(jie)構(gou)(gou)(gou)的(de)(de)(de)(de)(de)設計中采用(yong)(yong)了(le)冗余化和(he)分段處(chu)理(li)(li)(li)的(de)(de)(de)(de)(de)思想(xiang)，使得系(xi)統數(shu)(shu)據(ju)不僅滿(man)足(zu)(zu)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)，同(tong)時滿(man)足(zu)(zu)社(she)會(hui)(hui)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)各險(xian)(xian)(xian)種(zhong)的(de)(de)(de)(de)(de)需要(yao)(yao)(yao)。分段處(chu)理(li)(li)(li)的(de)(de)(de)(de)(de)設計，可(ke)以(yi)使不同(tong)的(de)(de)(de)(de)(de)險(xian)(xian)(xian)種(zhong)業務(wu)構(gou)(gou)(gou)件處(chu)理(li)(li)(li)對(dui)應區(qu)段的(de)(de)(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)業務(wu)。為了(le)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)證這(zhe)些要(yao)(yao)(yao)求(qiu)的(de)(de)(de)(de)(de)實現，主(zhu)要(yao)(yao)(yao)涉(she)及(ji)到了(le)一(yi)下(xia)部(bu)(bu)門(men)：勞動行政(zheng)(zheng)(zheng)主(zhu)管(guan)(guan)(guan)(guan)部(bu)(bu)門(men)、醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)中心、定(ding)(ding)(ding)點醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)機構(gou)(gou)(gou)（定(ding)(ding)(ding)點醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)和(he)定(ding)(ding)(ding)點藥店）、參(can)(can)(can)(can)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)、參(can)(can)(can)(can)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)職(zhi)工(gong)(gong)、財(cai)政(zheng)(zheng)(zheng)部(bu)(bu)門(men)、經辦(ban)(ban)銀(yin)行等(deng)單(dan)(dan)位(wei)。1、勞動行政(zheng)(zheng)(zheng)主(zhu)管(guan)(guan)(guan)(guan)部(bu)(bu)門(men)：制定(ding)(ding)(ding)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)登(deng)記(ji)管(guan)(guan)(guan)(guan)理(li)(li)(li)、基(ji)(ji)金(jin)(jin)征繳(jiao)管(guan)(guan)(guan)(guan)理(li)(li)(li)、基(ji)(ji)金(jin)(jin)監(jian)督(du)檢查等(deng)政(zheng)(zheng)(zheng)策(ce)(ce)細(xi)則(ze)；會(hui)(hui)同(tong)衛生部(bu)(bu)門(men)、財(cai)政(zheng)(zheng)(zheng)部(bu)(bu)門(men)等(deng)有關部(bu)(bu)門(men)制定(ding)(ding)(ding)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)藥品目錄、診(zhen)療(liao)(liao)目錄、醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)服(fu)務(wu)設施標準及(ji)相應的(de)(de)(de)(de)(de)管(guan)(guan)(guan)(guan)理(li)(li)(li)辦(ban)(ban)法；對(dui)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)基(ji)(ji)金(jin)(jin)實行全面(mian)的(de)(de)(de)(de)(de)監(jian)督(du)管(guan)(guan)(guan)(guan)理(li)(li)(li)等(deng)。2、醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)中心：負(fu)責(ze)(ze)(ze)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)登(deng)記(ji)管(guan)(guan)(guan)(guan)理(li)(li)(li)、變更(geng)登(deng)記(ji)管(guan)(guan)(guan)(guan)理(li)(li)(li)、注銷(xiao)登(deng)記(ji)管(guan)(guan)(guan)(guan)理(li)(li)(li)；負(fu)責(ze)(ze)(ze)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)基(ji)(ji)金(jin)(jin)的(de)(de)(de)(de)(de)繳(jiao)費(fei)(fei)(fei)申報(bao)核定(ding)(ding)(ding)工(gong)(gong)作；負(fu)責(ze)(ze)(ze)管(guan)(guan)(guan)(guan)理(li)(li)(li)統籌基(ji)(ji)金(jin)(jin)收支；負(fu)責(ze)(ze)(ze)完成參(can)(can)(can)(can)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)職(zhi)工(gong)(gong)的(de)(de)(de)(de)(de)特(te)殊醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)費(fei)(fei)(fei)用(yong)(yong)的(de)(de)(de)(de)(de)報(bao)銷(xiao)；負(fu)責(ze)(ze)(ze)定(ding)(ding)(ding)期(qi)與(yu)定(ding)(ding)(ding)點醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)機構(gou)(gou)(gou)進(jin)行費(fei)(fei)(fei)用(yong)(yong)結(jie)(jie)(jie)算(suan)(suan)；負(fu)責(ze)(ze)(ze)監(jian)督(du)檢查醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)政(zheng)(zheng)(zheng)策(ce)(ce)在(zai)(zai)各定(ding)(ding)(ding)點醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)機構(gou)(gou)(gou)的(de)(de)(de)(de)(de)執行情(qing)況。3、定(ding)(ding)(ding)點醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)：向參(can)(can)(can)(can)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)患(huan)者提供醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)服(fu)務(wu)；按(an)(an)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)政(zheng)(zheng)(zheng)策(ce)(ce)與(yu)參(can)(can)(can)(can)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)患(huan)者進(jin)行結(jie)(jie)(jie)算(suan)(suan)；向社(she)會(hui)(hui)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)事(shi)業管(guan)(guan)(guan)(guan)理(li)(li)(li)局(ju)(ju)提供詳(xiang)細(xi)的(de)(de)(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)數(shu)(shu)據(ju)；按(an)(an)政(zheng)(zheng)(zheng)策(ce)(ce)與(yu)社(she)會(hui)(hui)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)事(shi)業管(guan)(guan)(guan)(guan)理(li)(li)(li)局(ju)(ju)結(jie)(jie)(jie)算(suan)(suan)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)費(fei)(fei)(fei)用(yong)(yong)。4、參(can)(can)(can)(can)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)單(dan)(dan)位(wei)：管(guan)(guan)(guan)(guan)理(li)(li)(li)本(ben)單(dan)(dan)位(wei)參(can)(can)(can)(can)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)職(zhi)工(gong)(gong)的(de)(de)(de)(de)(de)基(ji)(ji)本(ben)資料；向社(she)會(hui)(hui)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)事(shi)業管(guan)(guan)(guan)(guan)理(li)(li)(li)局(ju)(ju)辦(ban)(ban)理(li)(li)(li)參(can)(can)(can)(can)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)登(deng)記(ji)、變更(geng)登(deng)記(ji)；按(an)(an)時進(jin)行醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)(fei)(fei)的(de)(de)(de)(de)(de)繳(jiao)費(fei)(fei)(fei)申報(bao)；代(dai)扣代(dai)繳(jiao)本(ben)單(dan)(dan)位(wei)職(zhi)工(gong)(gong)個(ge)人應繳(jiao)納(na)(na)的(de)(de)(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)(fei)(fei)；按(an)(an)時繳(jiao)納(na)(na)基(ji)(ji)本(ben)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)(fei)(fei)；定(ding)(ding)(ding)期(qi)代(dai)表單(dan)(dan)位(wei)職(zhi)工(gong)(gong)到醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)中心辦(ban)(ban)理(li)(li)(li)報(bao)銷(xiao)業務(wu)。5、參(can)(can)(can)(can)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)職(zhi)工(gong)(gong)：按(an)(an)月繳(jiao)納(na)(na)個(ge)人應繳(jiao)納(na)(na)的(de)(de)(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)(fei)(fei)；持醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)IC卡到各定(ding)(ding)(ding)點醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)機構(gou)(gou)(gou)就醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)或購(gou)藥。6、銀(yin)行：負(fu)責(ze)(ze)(ze)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)個(ge)人賬戶(hu)和(he)統籌基(ji)(ji)金(jin)(jin)賬戶(hu)的(de)(de)(de)(de)(de)建(jian)立；給醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)機構(gou)(gou)(gou)、藥店撥付資金(jin)(jin)；受社(she)會(hui)(hui)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)事(shi)業管(guan)(guan)(guan)(guan)理(li)(li)(li)局(ju)(ju)委托，強制收繳(jiao)繳(jiao)費(fei)(fei)(fei)單(dan)(dan)位(wei)的(de)(de)(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)(bao)險(xian)(xian)(xian)費(fei)(fei)(fei)等(deng)。

四、結論

在(zai)軟(ruan)件(jian)(jian)項目(mu)(mu)的(de)(de)(de)開(kai)發過程(cheng)(cheng)中，需(xu)(xu)(xu)求(qiu)變(bian)(bian)更(geng)(geng)貫(guan)穿了軟(ruan)件(jian)(jian)項目(mu)(mu)的(de)(de)(de)整個生命周期，從(cong)軟(ruan)件(jian)(jian)的(de)(de)(de)項目(mu)(mu)立項，研發，維護(hu)，用戶的(de)(de)(de)經(jing)驗在(zai)增(zeng)加(jia)，對使用軟(ruan)件(jian)(jian)的(de)(de)(de)感受(shou)有變(bian)(bian)化，以及整個行業的(de)(de)(de)新動態(tai)，都為軟(ruan)件(jian)(jian)帶來(lai)不斷(duan)完善功能(neng)、優化性(xing)能(neng)、提高用戶友好性(xing)的(de)(de)(de)要(yao)求(qiu)。在(zai)軟(ruan)件(jian)(jian)項目(mu)(mu)管(guan)(guan)(guan)(guan)理(li)過程(cheng)(cheng)中，項目(mu)(mu)經(jing)理(li)經(jing)常面對用戶的(de)(de)(de)需(xu)(xu)(xu)求(qiu)變(bian)(bian)更(geng)(geng)。如果不能(neng)有效(xiao)處理(li)這(zhe)些需(xu)(xu)(xu)求(qiu)變(bian)(bian)更(geng)(geng)，項目(mu)(mu)計劃會一(yi)再調整，軟(ruan)件(jian)(jian)交(jiao)(jiao)付日期一(yi)再拖延(yan)，項目(mu)(mu)研發人員的(de)(de)(de)士(shi)氣將(jiang)越來(lai)越低落，將(jiang)直接導致(zhi)項目(mu)(mu)成本增(zeng)加(jia)、質量下降及項目(mu)(mu)交(jiao)(jiao)付日期推后。這(zhe)決定(ding)了項目(mu)(mu)組(zu)必須擁有需(xu)(xu)(xu)求(qiu)管(guan)(guan)(guan)(guan)理(li)策略。在(zai)開(kai)發實(shi)踐中，首先應(ying)該不斷(duan)地(di)探索(suo)需(xu)(xu)(xu)求(qiu)，分(fen)析(xi)需(xu)(xu)(xu)求(qiu)，實(shi)現需(xu)(xu)(xu)求(qiu)，響(xiang)應(ying)需(xu)(xu)(xu)求(qiu)的(de)(de)(de)變(bian)(bian)更(geng)(geng)。在(zai)需(xu)(xu)(xu)求(qiu)開(kai)發的(de)(de)(de)整個過程(cheng)(cheng)中，應(ying)該從(cong)本質開(kai)始，邊捕(bu)獲、邊分(fen)析(xi)、邊實(shi)現，通過不斷(duan)的(de)(de)(de)迭代(dai)交(jiao)(jiao)付來(lai)響(xiang)應(ying)需(xu)(xu)(xu)求(qiu)變(bian)(bian)化，以需(xu)(xu)(xu)求(qiu)基線來(lai)保證開(kai)發的(de)(de)(de)節奏，通過對變(bian)(bian)更(geng)(geng)的(de)(de)(de)管(guan)(guan)(guan)(guan)理(li)來(lai)更(geng)(geng)好地(di)響(xiang)應(ying)變(bian)(bian)化。總而(er)言(yan)之，需(xu)(xu)(xu)求(qiu)管(guan)(guan)(guan)(guan)理(li)是整個開(kai)發生命周期中的(de)(de)(de)重中之重。在(zai)將(jiang)來(lai)的(de)(de)(de)發展中，需(xu)(xu)(xu)求(qiu)管(guan)(guan)(guan)(guan)理(li)將(jiang)起到(dao)至關重要(yao)的(de)(de)(de)作用。

參考文獻：

[1]崔(cui)立元(yuan),羅燕京,李剛(gang).基于企(qi)事業模型的軟件需求工(gong)程(cheng)方法[J].計(ji)算機(ji)工(gong)程(cheng)與應用,2002(7).

[2]別春(chun)麗.對開發與管理軟件需求的探討[J].中國金融(rong)電腦,2001(10).

[3]苗(miao)炬.基于RUP的軟件需求(qiu)分析[J].計(ji)算機(ji)與網絡,2003(3).

篇8

關鍵(jian)詞：社保基(ji)金　投資管理　問題　對策

一、社保(bao)基金(jin)運營過程中存在(zai)的問題

隨著我國(guo)社(she)(she)會保(bao)障事業的(de)發展(zhan)，社(she)(she)會保(bao)障基(ji)(ji)金的(de)規模(mo)日(ri)益擴大(da)，如何加(jia)強投(tou)資管(guan)理(li)使其保(bao)值增(zeng)值，是現階(jie)段必(bi)須解決的(de)一大(da)課題。筆(bi)者在實際工作中體(ti)會到現階(jie)段社(she)(she)保(bao)基(ji)(ji)金運營過(guo)程(cheng)中存在以下問(wen)題：

1.統(tong)籌(chou)(chou)層次(ci)(ci)不(bu)同，基(ji)金(jin)(jin)管理(li)(li)主(zhu)體分(fen)散，影(ying)響了(le)基(ji)金(jin)(jin)的(de)(de)存量規模，削(xue)弱(ruo)了(le)基(ji)金(jin)(jin)運營的(de)(de)規模效益(yi)。目(mu)前地方保(bao)險基(ji)金(jin)(jin)的(de)(de)統(tong)籌(chou)(chou)層次(ci)(ci)也不(bu)盡相(xiang)同，中央(yang)和(he)(he)省屬企業(ye)養老(lao)保(bao)險、失業(ye)保(bao)險實(shi)行了(le)省級統(tong)籌(chou)(chou)，醫療(liao)、生育、工(gong)傷(shang)保(bao)險實(shi)行地市級統(tong)籌(chou)(chou)或縣級統(tong)籌(chou)(chou)，統(tong)籌(chou)(chou)的(de)(de)層次(ci)(ci)還(huan)處在較低的(de)(de)水平。一(yi)些企業(ye)還(huan)建立了(le)補(bu)(bu)充醫療(liao)保(bao)險和(he)(he)補(bu)(bu)充養老(lao)保(bao)險，企業(ye)是(shi)補(bu)(bu)充保(bao)險基(ji)金(jin)(jin)的(de)(de)管理(li)(li)主(zhu)體。這樣(yang)的(de)(de)管理(li)(li)體制，使基(ji)金(jin)(jin)節余分(fen)散，管理(li)(li)難度增大。

2.基金管(guan)理制度的(de)(de)(de)約束(shu)。在(zai)(zai)保險(xian)基金的(de)(de)(de)管(guan)理上，前一(yi)時期，確(que)實存(cun)在(zai)(zai)大量基金被擠占(zhan)和挪用的(de)(de)(de)現象，在(zai)(zai)這種情況下(xia)，國家嚴格限制了基金的(de)(de)(de)投資(zi)(zi)渠(qu)道，只(zhi)(zhi)允許投資(zi)(zi)國債和銀行(xing)定(ding)期存(cun)款。在(zai)(zai)資(zi)(zi)本市場發育的(de)(de)(de)初期，防范(fan)風險(xian)的(de)(de)(de)能力較(jiao)小，對社保基金的(de)(de)(de)投資(zi)(zi)范(fan)圍作(zuo)出限制是(shi)必要的(de)(de)(de)，但是(shi)不應當成為一(yi)個長期的(de)(de)(de)政策選擇(ze)。就目前講，只(zhi)(zhi)有(you)國家級(ji)社會保險(xian)基金有(you)投資(zi)(zi)管(guan)理的(de)(de)(de)辦(ban)法，詳細規(gui)定(ding)了投資(zi)(zi)的(de)(de)(de)渠(qu)道和管(guan)理方(fang)法，地方(fang)結余保險(xian)基金的(de)(de)(de)投資(zi)(zi)渠(qu)道還沒有(you)打開。

3.基金(jin)運(yun)(yun)營不(bu)規范。社(she)會(hui)(hui)保(bao)險基金(jin)運(yun)(yun)營主體的非(fei)專業性(xing)(xing)以及(ji)過(guo)多(duo)的行政(zheng)干預(yu)導致基金(jin)運(yun)(yun)營的低效率(lv)、高風險并存。從目前社(she)會(hui)(hui)保(bao)險基金(jin)的管理(li)(li)機構(gou)設(she)置來(lai)看，社(she)會(hui)(hui)保(bao)險的事(shi)務性(xing)(xing)管理(li)(li)和基金(jin)的運(yun)(yun)營都是(shi)由政(zheng)府組(zu)建(jian)的事(shi)業性(xing)(xing)機構(gou)即(ji)社(she)會(hui)(hui)保(bao)險管理(li)(li)局（中(zhong)心）來(lai)管理(li)(li)，其管理(li)(li)模式是(shi)政(zheng)府行政(zheng)命(ming)令式的管理(li)(li)，而非(fei)市場指導下的商(shang)業化(hua)運(yun)(yun)作(zuo)，這使基金(jin)在運(yun)(yun)營過(guo)程中(zhong)存在很大弊病(bing)。

二、目(mu)前應(ying)采取的具體(ti)措施

1.國家應(ying)盡快制(zhi)(zhi)定保(bao)險(xian)(xian)基(ji)(ji)金的(de)(de)(de)投(tou)(tou)資(zi)管(guan)(guan)(guan)理(li)(li)辦(ban)(ban)(ban)法(fa)(fa)，依(yi)法(fa)(fa)管(guan)(guan)(guan)理(li)(li)和規范基(ji)(ji)金投(tou)(tou)資(zi)。盡管(guan)(guan)(guan)有中央管(guan)(guan)(guan)理(li)(li)的(de)(de)(de)社(she)(she)會(hui)保(bao)險(xian)(xian)基(ji)(ji)金投(tou)(tou)資(zi)管(guan)(guan)(guan)理(li)(li)辦(ban)(ban)(ban)法(fa)(fa)，但還不是全部(bu)保(bao)險(xian)(xian)基(ji)(ji)金的(de)(de)(de)投(tou)(tou)資(zi)管(guan)(guan)(guan)理(li)(li)辦(ban)(ban)(ban)法(fa)(fa)，對其他保(bao)險(xian)(xian)基(ji)(ji)金的(de)(de)(de)投(tou)(tou)資(zi)管(guan)(guan)(guan)理(li)(li)還是空(kong)白。社(she)(she)保(bao)基(ji)(ji)金關系(xi)到廣大人民(min)群眾根(gen)本利(li)益，需要以立(li)(li)法(fa)(fa)的(de)(de)(de)形式(shi)加以保(bao)證。因此，應(ying)盡快對社(she)(she)會(hui)保(bao)險(xian)(xian)基(ji)(ji)金投(tou)(tou)資(zi)立(li)(li)法(fa)(fa)，依(yi)法(fa)(fa)管(guan)(guan)(guan)理(li)(li)基(ji)(ji)金的(de)(de)(de)投(tou)(tou)資(zi)，財務風險(xian)(xian)的(de)(de)(de)防范都應(ying)制(zhi)(zhi)度化(hua)(hua)、法(fa)(fa)制(zhi)(zhi)化(hua)(hua)，使社(she)(she)會(hui)保(bao)險(xian)(xian)基(ji)(ji)金在運行過(guo)程中真正做到有章可(ke)循、有法(fa)(fa)可(ke)依(yi)，防止出現管(guan)(guan)(guan)理(li)(li)混亂的(de)(de)(de)現象，給國家經濟和社(she)(she)會(hui)的(de)(de)(de)穩定造成不利(li)影響。

2.建(jian)立(li)(li)社會保(bao)險基(ji)(ji)金(jin)(jin)的(de)(de)(de)投資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)機(ji)(ji)(ji)(ji)構(gou)(gou)和(he)(he)監(jian)(jian)管(guan)(guan)(guan)(guan)機(ji)(ji)(ji)(ji)構(gou)(gou)。國(guo)家、省、市(shi)應建(jian)立(li)(li)起保(bao)險基(ji)(ji)金(jin)(jin)的(de)(de)(de)投資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)機(ji)(ji)(ji)(ji)構(gou)(gou)和(he)(he)監(jian)(jian)督(du)管(guan)(guan)(guan)(guan)理(li)機(ji)(ji)(ji)(ji)構(gou)(gou)，明確各自(zi)(zi)的(de)(de)(de)工作職(zhi)責，按照基(ji)(ji)金(jin)(jin)投資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)辦(ban)法(fa)進(jin)行投資(zi)(zi)和(he)(he)監(jian)(jian)督(du)管(guan)(guan)(guan)(guan)理(li)。投資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)部(bu)(bu)門(men)和(he)(he)監(jian)(jian)管(guan)(guan)(guan)(guan)部(bu)(bu)門(men)應相(xiang)互(hu)制(zhi)(zhi)約(yue)(yue)，有各自(zi)(zi)的(de)(de)(de)職(zhi)責，互(hu)不隸屬。投資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)部(bu)(bu)門(men)內部(bu)(bu)要嚴格(ge)遵守國(guo)家投資(zi)(zi)法(fa)規(gui)和(he)(he)政(zheng)策進(jin)行投資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)，監(jian)(jian)管(guan)(guan)(guan)(guan)部(bu)(bu)門(men)還應具(ju)有較強的(de)(de)(de)獨立(li)(li)性，按照法(fa)律規(gui)定的(de)(de)(de)投資(zi)(zi)辦(ban)法(fa)進(jin)行獨立(li)(li)的(de)(de)(de)監(jian)(jian)督(du)和(he)(he)檢查，確保(bao)基(ji)(ji)金(jin)(jin)按照規(gui)定去運轉(zhuan)。同時，應建(jian)立(li)(li)分權(quan)制(zhi)(zhi)衡(heng)的(de)(de)(de)運作機(ji)(ji)(ji)(ji)制(zhi)(zhi)，基(ji)(ji)金(jin)(jin)的(de)(de)(de)運用決策系統(tong)、執行系統(tong)、考核監(jian)(jian)控系統(tong)，由此形成(cheng)相(xiang)互(hu)協調，相(xiang)互(hu)制(zhi)(zhi)約(yue)(yue)的(de)(de)(de)分權(quan)制(zhi)(zhi)衡(heng)機(ji)(ji)(ji)(ji)制(zhi)(zhi)。

3.社保(bao)基(ji)金的(de)(de)投(tou)資(zi)應明(ming)確規定為委(wei)托理財(cai)。目前(qian)社會保(bao)險(xian)(xian)經辦(ban)機(ji)構(gou)專業理財(cai)人員(yuan)還不多(duo)，也沒有資(zi)本市場投(tou)資(zi)經驗，直接投(tou)資(zi)風險(xian)(xian)比(bi)較大，考慮(lv)到社保(bao)基(ji)金的(de)(de)收益(yi)目標(biao)和風險(xian)(xian)，通過委(wei)托和關系，簽訂合同，實現進入資(zi)本市場是比(bi)較好的(de)(de)選擇(ze)。

4.在基(ji)(ji)(ji)金(jin)(jin)投(tou)資(zi)過(guo)程(cheng)中(zhong)，應處理好(hao)投(tou)資(zi)組合問(wen)題。目(mu)前，全國(guo)社(she)會保(bao)險基(ji)(ji)(ji)金(jin)(jin)的(de)(de)投(tou)資(zi)限制是，銀行存(cun)款(kuan)和(he)(he)國(guo)債的(de)(de)比(bi)(bi)例不(bu)得低(di)于(yu)(yu)50%，企業(ye)債券(quan)、金(jin)(jin)融債券(quan)不(bu)得高(gao)于(yu)(yu)10%，證券(quan)基(ji)(ji)(ji)金(jin)(jin)、股票投(tou)資(zi)比(bi)(bi)例不(bu)得高(gao)于(yu)(yu)40%.當(dang)前我國(guo)金(jin)(jin)融市場還(huan)不(bu)發達(da)，保(bao)險基(ji)(ji)(ji)金(jin)(jin)還(huan)存(cun)在較大的(de)(de)隱(yin)性(xing)債務(wu)，對于(yu)(yu)股票和(he)(he)證券(quan)基(ji)(ji)(ji)金(jin)(jin)的(de)(de)投(tou)資(zi)應保(bao)持較低(di)比(bi)(bi)例。

5.在(zai)基(ji)金(jin)的運(yun)作過程中，可以考(kao)慮以下幾種投(tou)資形式：投(tou)資開放式基(ji)金(jin)；發行(xing)定(ding)期保(bao)險基(ji)金(jin)的國(guo)債(zhai)；委托(tuo)銀行(xing)抵押貸款；公司或企業(ye)債(zhai)券。

篇9

關鍵詞：社保基金投資管理問題對策(ce)

一、社保基金運營(ying)過程中(zhong)存在的問題(ti)

隨著(zhu)我國社(she)會保(bao)障事業的(de)發展，社(she)會保(bao)障基金的(de)規模日(ri)益擴大，如(ru)何加強(qiang)投資管理(li)使其保(bao)值(zhi)增值(zhi)，是現階(jie)段(duan)必須(xu)解決的(de)一大課題。筆者在(zai)實(shi)際工作中體(ti)會到現階(jie)段(duan)社(she)保(bao)基金運營(ying)過程(cheng)中存(cun)在(zai)以下問(wen)題：

1.統(tong)(tong)(tong)籌(chou)層(ceng)次(ci)不(bu)同，基(ji)(ji)金管理(li)主體分(fen)散，影響了(le)基(ji)(ji)金的(de)存量規模，削弱了(le)基(ji)(ji)金運(yun)營(ying)的(de)規模效益。目前地方(fang)保(bao)(bao)險(xian)基(ji)(ji)金的(de)統(tong)(tong)(tong)籌(chou)層(ceng)次(ci)也不(bu)盡相同，中央和(he)(he)省屬企業(ye)養老(lao)保(bao)(bao)險(xian)、失業(ye)保(bao)(bao)險(xian)實行了(le)省級統(tong)(tong)(tong)籌(chou)，醫療、生育、工傷保(bao)(bao)險(xian)實行地市級統(tong)(tong)(tong)籌(chou)或縣級統(tong)(tong)(tong)籌(chou)，統(tong)(tong)(tong)籌(chou)的(de)層(ceng)次(ci)還處在較低(di)的(de)水平。一些企業(ye)還建立了(le)補充(chong)醫療保(bao)(bao)險(xian)和(he)(he)補充(chong)養老(lao)保(bao)(bao)險(xian)，企業(ye)是補充(chong)保(bao)(bao)險(xian)基(ji)(ji)金的(de)管理(li)主體。這(zhe)樣的(de)管理(li)體制，使基(ji)(ji)金節余分(fen)散，管理(li)難度增大。

2.基(ji)金(jin)管(guan)(guan)理制度(du)的(de)(de)(de)約束。在保險基(ji)金(jin)的(de)(de)(de)管(guan)(guan)理上，前一時期，確實存(cun)在大(da)量(liang)基(ji)金(jin)被擠占和(he)挪用的(de)(de)(de)現象，在這(zhe)種(zhong)情況下，國(guo)家嚴格限制了(le)基(ji)金(jin)的(de)(de)(de)投(tou)資(zi)(zi)(zi)渠道(dao)，只(zhi)允(yun)許投(tou)資(zi)(zi)(zi)國(guo)債和(he)銀行(xing)定期存(cun)款(kuan)。在資(zi)(zi)(zi)本(ben)市場(chang)發(fa)育(yu)的(de)(de)(de)初期，防范風險的(de)(de)(de)能力較小，對(dui)社保基(ji)金(jin)的(de)(de)(de)投(tou)資(zi)(zi)(zi)范圍作出限制是(shi)必(bi)要的(de)(de)(de)，但是(shi)不(bu)應(ying)當(dang)成為一個長期的(de)(de)(de)政策選擇。就目(mu)前講，只(zhi)有國(guo)家級社會保險基(ji)金(jin)有投(tou)資(zi)(zi)(zi)管(guan)(guan)理的(de)(de)(de)辦(ban)法(fa)，詳(xiang)細規定了(le)投(tou)資(zi)(zi)(zi)的(de)(de)(de)渠道(dao)和(he)管(guan)(guan)理方(fang)法(fa)，地方(fang)結余保險基(ji)金(jin)的(de)(de)(de)投(tou)資(zi)(zi)(zi)渠道(dao)還沒有打開。

3.基(ji)金(jin)運營(ying)不規范。社會保(bao)險基(ji)金(jin)運營(ying)主(zhu)體的(de)(de)(de)非(fei)專業性以及(ji)過多的(de)(de)(de)行(xing)(xing)政干預導致基(ji)金(jin)運營(ying)的(de)(de)(de)低效率(lv)、高(gao)風險并存。從目前社會保(bao)險基(ji)金(jin)的(de)(de)(de)管(guan)(guan)理(li)(li)機構設置來看，社會保(bao)險的(de)(de)(de)事(shi)(shi)務性管(guan)(guan)理(li)(li)和基(ji)金(jin)的(de)(de)(de)運營(ying)都是由政府組建的(de)(de)(de)事(shi)(shi)業性機構即社會保(bao)險管(guan)(guan)理(li)(li)局（中心(xin)）來管(guan)(guan)理(li)(li)，其管(guan)(guan)理(li)(li)模式(shi)是政府行(xing)(xing)政命令式(shi)的(de)(de)(de)管(guan)(guan)理(li)(li)，而非(fei)市場(chang)指導下的(de)(de)(de)商(shang)業化(hua)運作，這使基(ji)金(jin)在運營(ying)過程中存在很(hen)大弊病(bing)。

二、目前應采取的具體措施

1.國(guo)家應(ying)盡(jin)快制(zhi)(zhi)定(ding)(ding)保(bao)(bao)(bao)險(xian)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)的(de)(de)(de)投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)辦(ban)法(fa)(fa)(fa)(fa)(fa)，依(yi)法(fa)(fa)(fa)(fa)(fa)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)和(he)(he)規范(fan)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)投(tou)(tou)(tou)(tou)資(zi)(zi)。盡(jin)管(guan)(guan)(guan)(guan)有(you)(you)中(zhong)央管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)的(de)(de)(de)社會(hui)保(bao)(bao)(bao)險(xian)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)辦(ban)法(fa)(fa)(fa)(fa)(fa)，但還(huan)不是(shi)全部(bu)保(bao)(bao)(bao)險(xian)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)的(de)(de)(de)投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)辦(ban)法(fa)(fa)(fa)(fa)(fa)，對其他保(bao)(bao)(bao)險(xian)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)的(de)(de)(de)投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)還(huan)是(shi)空白。社保(bao)(bao)(bao)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)關系(xi)(xi)到廣大人民群(qun)眾根本利(li)益，需要(yao)以立(li)法(fa)(fa)(fa)(fa)(fa)的(de)(de)(de)形式加(jia)以保(bao)(bao)(bao)證。因此(ci)(ci)，應(ying)盡(jin)快對社會(hui)保(bao)(bao)(bao)險(xian)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)投(tou)(tou)(tou)(tou)資(zi)(zi)立(li)法(fa)(fa)(fa)(fa)(fa)，依(yi)法(fa)(fa)(fa)(fa)(fa)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)的(de)(de)(de)投(tou)(tou)(tou)(tou)資(zi)(zi)，財務風(feng)險(xian)的(de)(de)(de)防范(fan)都應(ying)制(zhi)(zhi)度化、法(fa)(fa)(fa)(fa)(fa)制(zhi)(zhi)化，使社會(hui)保(bao)(bao)(bao)險(xian)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)在運行(xing)過程(cheng)中(zhong)真正做到有(you)(you)章(zhang)可(ke)循、有(you)(you)法(fa)(fa)(fa)(fa)(fa)可(ke)依(yi)，防止出現管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)混亂的(de)(de)(de)現象，給國(guo)家經濟和(he)(he)社會(hui)的(de)(de)(de)穩定(ding)(ding)造成不利(li)影響。2.建立(li)社會(hui)保(bao)(bao)(bao)險(xian)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)的(de)(de)(de)投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)機(ji)構和(he)(he)監(jian)管(guan)(guan)(guan)(guan)機(ji)構。國(guo)家、省(sheng)、市(shi)應(ying)建立(li)起保(bao)(bao)(bao)險(xian)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)的(de)(de)(de)投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)機(ji)構和(he)(he)監(jian)督管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)機(ji)構，明(ming)確各(ge)自(zi)的(de)(de)(de)工作(zuo)職(zhi)責(ze)，按照(zhao)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)辦(ban)法(fa)(fa)(fa)(fa)(fa)進(jin)(jin)行(xing)投(tou)(tou)(tou)(tou)資(zi)(zi)和(he)(he)監(jian)督管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)。投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)部(bu)門(men)和(he)(he)監(jian)管(guan)(guan)(guan)(guan)部(bu)門(men)應(ying)相互(hu)制(zhi)(zhi)約，有(you)(you)各(ge)自(zi)的(de)(de)(de)職(zhi)責(ze)，互(hu)不隸屬。投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)部(bu)門(men)內部(bu)要(yao)嚴格遵守國(guo)家投(tou)(tou)(tou)(tou)資(zi)(zi)法(fa)(fa)(fa)(fa)(fa)規和(he)(he)政策進(jin)(jin)行(xing)投(tou)(tou)(tou)(tou)資(zi)(zi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)，監(jian)管(guan)(guan)(guan)(guan)部(bu)門(men)還(huan)應(ying)具有(you)(you)較(jiao)強(qiang)的(de)(de)(de)獨立(li)性，按照(zhao)法(fa)(fa)(fa)(fa)(fa)律規定(ding)(ding)的(de)(de)(de)投(tou)(tou)(tou)(tou)資(zi)(zi)辦(ban)法(fa)(fa)(fa)(fa)(fa)進(jin)(jin)行(xing)獨立(li)的(de)(de)(de)監(jian)督和(he)(he)檢查，確保(bao)(bao)(bao)基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)按照(zhao)規定(ding)(ding)去運轉。同(tong)時，應(ying)建立(li)分(fen)權制(zhi)(zhi)衡的(de)(de)(de)運作(zuo)機(ji)制(zhi)(zhi)，基(ji)(ji)(ji)金(jin)(jin)(jin)(jin)(jin)的(de)(de)(de)運用決策系(xi)(xi)統(tong)、執行(xing)系(xi)(xi)統(tong)、考(kao)核監(jian)控系(xi)(xi)統(tong)，由此(ci)(ci)形成相互(hu)協調，相互(hu)制(zhi)(zhi)約的(de)(de)(de)分(fen)權制(zhi)(zhi)衡機(ji)制(zhi)(zhi)。

3.社保基金的(de)(de)投(tou)(tou)資(zi)應明確規定(ding)為委(wei)托(tuo)(tuo)理(li)(li)財(cai)。目(mu)前社會保險(xian)(xian)(xian)經(jing)辦機構專業理(li)(li)財(cai)人員(yuan)還不多，也(ye)沒有資(zi)本市(shi)場投(tou)(tou)資(zi)經(jing)驗，直接投(tou)(tou)資(zi)風險(xian)(xian)(xian)比(bi)較大，考慮到社保基金的(de)(de)收(shou)益目(mu)標和風險(xian)(xian)(xian)，通過(guo)委(wei)托(tuo)(tuo)和關系(xi)，簽訂(ding)合同，實(shi)現進入資(zi)本市(shi)場是比(bi)較好(hao)的(de)(de)選(xuan)擇(ze)。

4.在(zai)(zai)基(ji)金投(tou)(tou)資過程中(zhong)，應(ying)處理好(hao)投(tou)(tou)資組合問題。目前，全國(guo)社會(hui)保險基(ji)金的(de)投(tou)(tou)資限(xian)制是，銀行(xing)存(cun)款和國(guo)債(zhai)的(de)比例(li)(li)不得低(di)于(yu)50%，企(qi)業債(zhai)券(quan)、金融債(zhai)券(quan)不得高(gao)于(yu)10%，證券(quan)基(ji)金、股票(piao)投(tou)(tou)資比例(li)(li)不得高(gao)于(yu)40%.當前我國(guo)金融市場還不發達，保險基(ji)金還存(cun)在(zai)(zai)較(jiao)大的(de)隱性債(zhai)務，對于(yu)股票(piao)和證券(quan)基(ji)金的(de)投(tou)(tou)資應(ying)保持較(jiao)低(di)比例(li)(li)。

5.在(zai)基(ji)金的運作過(guo)程中，可以考(kao)慮以下幾(ji)種投資形式：投資開放式基(ji)金；發行定期(qi)保險基(ji)金的國(guo)債；委托銀行抵(di)押貸款；公司或企(qi)業債券。

篇10

關鍵詞：健康(kang)保險　現狀　問題　對(dui)策

[中圖分(fen)類號]D669　[文(wen)獻識(shi)別碼]A　[文(wen)章編號]1004-7069(2011)-02-0152-02

一(yi)、我國健(jian)康保險發展現狀(zhuang)分析(xi)

我(wo)國的(de)(de)(de)(de)(de)健(jian)(jian)康保(bao)(bao)險(xian)發展開始于上世(shi)紀(ji)80年(nian)代保(bao)(bao)險(xian)業全面復蘇(su)的(de)(de)(de)(de)(de)時點，時至(zhi)今日，已取得了(le)不(bu)小的(de)(de)(de)(de)(de)進(jin)步。一(yi)方(fang)面，社會保(bao)(bao)障(zhang)的(de)(de)(de)(de)(de)覆蓋面在逐步擴(kuo)大(da)，保(bao)(bao)障(zhang)力度(du)在不(bu)斷加強，總的(de)(de)(de)(de)(de)來說社會保(bao)(bao)障(zhang)是“低水平、廣覆蓋”。另一(yi)方(fang)面，我(wo)國醫療(liao)費用(yong)的(de)(de)(de)(de)(de)偏(pian)低是不(bu)爭的(de)(de)(de)(de)(de)事實，在這一(yi)方(fang)面，仍有(you)很大(da)的(de)(de)(de)(de)(de)缺口(kou)需要弼補。在人們的(de)(de)(de)(de)(de)多種醫療(liao)需求(qiu)中，一(yi)些(xie)費用(yong)是社會保(bao)(bao)障(zhang)所無法給予的(de)(de)(de)(de)(de)，而商(shang)業健(jian)(jian)康保(bao)(bao)險(xian)對其的(de)(de)(de)(de)(de)很好(hao)補充就是最大(da)的(de)(de)(de)(de)(de)競(jing)爭點，同時也是其存在必要性的(de)(de)(de)(de)(de)很好(hao)例證。

1.社會健康保險

從(cong)資(zi)金(jin)(jin)來源來看(kan)，新(xin)(xin)的(de)(de)社(she)會(hui)(hui)(hui)(hui)健(jian)康(kang)保(bao)(bao)(bao)險(xian)(xian)強調單位(wei)(wei)與個(ge)(ge)人(ren)的(de)(de)責任(ren)，一(yi)改過(guo)去政府(fu)大包大攬(lan)的(de)(de)風(feng)格，要求(qiu)加入社(she)會(hui)(hui)(hui)(hui)健(jian)康(kang)保(bao)(bao)(bao)險(xian)(xian)體系(xi)的(de)(de)單位(wei)(wei)和個(ge)(ge)人(ren)承(cheng)擔一(yi)定(ding)的(de)(de)費(fei)用。從(cong)管理機(ji)構來看(kan)，全國由(you)新(xin)(xin)組建的(de)(de)社(she)會(hui)(hui)(hui)(hui)勞動保(bao)(bao)(bao)障部(bu)門(men)主管健(jian)康(kang)保(bao)(bao)(bao)險(xian)(xian)工(gong)作(zuo)，但各地做(zuo)法尚不統(tong)一(yi)，如深圳、成都、九(jiu)江、鎮江等地由(you)社(she)保(bao)(bao)(bao)局(ju)作(zuo)為(wei)社(she)會(hui)(hui)(hui)(hui)健(jian)康(kang)保(bao)(bao)(bao)險(xian)(xian)的(de)(de)管理機(ji)構；上海(hai)則由(you)健(jian)康(kang)保(bao)(bao)(bao)險(xian)(xian)局(ju)管理社(she)會(hui)(hui)(hui)(hui)健(jian)康(kang)保(bao)(bao)(bao)險(xian)(xian)。在待(dai)遇享(xiang)受方面，新(xin)(xin)的(de)(de)社(she)會(hui)(hui)(hui)(hui)健(jian)康(kang)保(bao)(bao)(bao)險(xian)(xian)將資(zi)金(jin)(jin)劃分為(wei)個(ge)(ge)人(ren)賬戶(hu)(hu)和社(she)會(hui)(hui)(hui)(hui)統(tong)籌(chou)賬戶(hu)(hu)兩部(bu)分，醫療費(fei)用先(xian)從(cong)個(ge)(ge)人(ren)賬戶(hu)(hu)中支付，個(ge)(ge)人(ren)賬戶(hu)(hu)用完后。進(jin)入社(she)會(hui)(hui)(hui)(hui)統(tong)籌(chou)賬戶(hu)(hu)支付，并(bing)提高了被保(bao)(bao)(bao)險(xian)(xian)人(ren)的(de)(de)自(zi)付比例，體現了“公平(ping)優先(xian)、兼顧效率”的(de)(de)社(she)會(hui)(hui)(hui)(hui)保(bao)(bao)(bao)障原則，在一(yi)定(ding)程度上有利于(yu)控(kong)制醫療費(fei)用的(de)(de)過(guo)度上漲。

2.商業健康保險

根據新的(de)(de)(de)保(bao)(bao)(bao)險(xian)(xian)(xian)法，財(cai)產保(bao)(bao)(bao)險(xian)(xian)(xian)公(gong)(gong)司(si)也允(yun)許開(kai)展(zhan)短期健康(kang)(kang)保(bao)(bao)(bao)險(xian)(xian)(xian)業(ye)(ye)(ye)(ye)務(wu)(wu)。從(cong)產品的(de)(de)(de)情況來看(kan)，主要有定額(e)給付型、費用(yong)報銷型以及住(zhu)院(yuan)(yuan)津貼(tie)型三大類(lei)，主要的(de)(de)(de)醫(yi)療險(xian)(xian)(xian)種有中國人(ren)壽的(de)(de)(de)生(sheng)命綠(lv)蔭疾(ji)病(bing)保(bao)(bao)(bao)險(xian)(xian)(xian)、關愛生(sheng)命女性疾(ji)病(bing)保(bao)(bao)(bao)險(xian)(xian)(xian)(A、B款)；中國太平洋的(de)(de)(de)長健健康(kang)(kang)保(bao)(bao)(bao)險(xian)(xian)(xian)(A、B款)、團(tuan)體重大疾(ji)病(bing)保(bao)(bao)(bao)險(xian)(xian)(xian)；中國平安(an)的(de)(de)(de)99住(zhu)院(yuan)(yuan)安(an)心保(bao)(bao)(bao)險(xian)(xian)(xian)、99住(zhu)院(yuan)(yuan)費用(yong)保(bao)(bao)(bao)險(xian)(xian)(xian)、平安(an)康(kang)(kang)泰保(bao)(bao)(bao)險(xian)(xian)(xian)等。近年(nian)(nian)(nian)來，各(ge)保(bao)(bao)(bao)險(xian)(xian)(xian)公(gong)(gong)司(si)對于健康(kang)(kang)保(bao)(bao)(bao)險(xian)(xian)(xian)業(ye)(ye)(ye)(ye)務(wu)(wu)性質(zhi)和特征(zheng)的(de)(de)(de)認識逐漸加深，業(ye)(ye)(ye)(ye)務(wu)(wu)發(fa)展(zhan)迅速(su)。保(bao)(bao)(bao)費收入(ru)呈(cheng)高(gao)(gao)速(su)增長態勢，年(nian)(nian)(nian)均增幅(fu)高(gao)(gao)達(da)(da)30％，而同期壽險(xian)(xian)(xian)保(bao)(bao)(bao)費增幅(fu)僅為14％；業(ye)(ye)(ye)(ye)務(wu)(wu)結構逐步(bu)從(cong)以團(tuan)險(xian)(xian)(xian)業(ye)(ye)(ye)(ye)務(wu)(wu)為主轉(zhuan)變為以個人(ren)業(ye)(ye)(ye)(ye)務(wu)(wu)為主，到(dao)2003年(nian)(nian)(nian)個人(ren)業(ye)(ye)(ye)(ye)務(wu)(wu)占比(bi)達(da)(da)到(dao)62.19％：商業(ye)(ye)(ye)(ye)健康(kang)(kang)保(bao)(bao)(bao)險(xian)(xian)(xian)覆(fu)蓋人(ren)群也逐步(bu)擴大。2001年(nian)(nian)(nian)商業(ye)(ye)(ye)(ye)健康(kang)(kang)保(bao)(bao)(bao)險(xian)(xian)(xian)承保(bao)(bao)(bao)人(ren)次(ci)首(shou)次(ci)突破(po)1億(yi)(yi)人(ren)次(ci)，2002年(nian)(nian)(nian)達(da)(da)到(dao)1.36億(yi)(yi)人(ren)次(ci)，2003年(nian)(nian)(nian)接近1.5億(yi)(yi)人(ren)次(ci)，醫(yi)療健康(kang)(kang)保(bao)(bao)(bao)險(xian)(xian)(xian)產品種類(lei)超過300種。目前，我國商業(ye)(ye)(ye)(ye)健康(kang)(kang)保(bao)(bao)(bao)險(xian)(xian)(xian)已經覆(fu)蓋了包括能源、煙(yan)草、鐵路、航空、郵政、通訊等支柱行業(ye)(ye)(ye)(ye)，社會影響正逐步(bu)擴大。

二、我國健康保險(xian)發展中存在的問題

1.目(mu)前我國健康保(bao)險(xian)市場很(hen)不規范，導(dao)致(zhi)現實中存(cun)在著兩大(da)矛盾，即“供(gong)求(qiu)矛盾”和“市場潛力與(yu)市場風險(xian)矛盾”

供求矛盾：

一方(fang)面(mian)市(shi)場空間大(da)得(de)驚人，另一方(fang)面(mian)保(bao)(bao)險(xian)公(gong)(gong)司(si)(si)躊躇不(bu)前；一方(fang)面(mian)社會(hui)公(gong)(gong)眾需求迫切，另一方(fang)面(mian)市(shi)場供給(gei)乏力。(1)有(you)效(xiao)供給(gei)不(bu)足(zu)，難以滿足(zu)居(ju)民的(de)(de)(de)巨大(da)需求。隨著(zhu)居(ju)民收入(ru)不(bu)斷(duan)提(ti)高、醫(yi)(yi)療費(fei)(fei)用快速(su)增長和(he)我國逐步進人人口老齡(ling)化階段，人民群眾的(de)(de)(de)健康(kang)(kang)(kang)保(bao)(bao)障(zhang)需求日益高漲(zhang)，健康(kang)(kang)(kang)保(bao)(bao)險(xian)前景十分廣闊。但(dan)從各壽險(xian)公(gong)(gong)司(si)(si)提(ti)供的(de)(de)(de)健康(kang)(kang)(kang)保(bao)(bao)險(xian)產品(pin)看，其(qi)范圍和(he)責(ze)任(ren)雷同，缺(que)乏特(te)色，缺(que)少(shao)(shao)市(shi)場細分，各公(gong)(gong)司(si)(si)在(zai)(zai)市(shi)場競爭(zheng)和(he)經營過程中(zhong)多以“價格戰(zhan)”和(he)“手續費(fei)(fei)”為主展(zhan)開競爭(zheng)。而很少(shao)(shao)在(zai)(zai)服務(wu)和(he)技術上(shang)比(bi)(bi)拼(pin)，尚(shang)未形(xing)成(cheng)競爭(zheng)優勢。(2]我國商(shang)業(ye)健康(kang)(kang)(kang)保(bao)(bao)險(xian)還處(chu)于初級階段，健康(kang)(kang)(kang)保(bao)(bao)險(xian)在(zai)(zai)人身保(bao)(bao)險(xian)業(ye)務(wu)中(zhong)的(de)(de)(de)比(bi)(bi)重較(jiao)小(xiao)。健康(kang)(kang)(kang)險(xian)在(zai)(zai)人身險(xian)總保(bao)(bao)費(fei)(fei)收入(ru)的(de)(de)(de)占比(bi)(bi)由1999年的(de)(de)(de)4.2％增至2005年的(de)(de)(de)8.4％，2006年的(de)(de)(de)8.81％；該比(bi)(bi)例自2003年起(qi)相對(dui)穩定，無(wu)顯著(zhu)增加。國際(ji)經驗顯示：一個成(cheng)熟(shu)的(de)(de)(de)保(bao)(bao)險(xian)市(shi)場，健康(kang)(kang)(kang)險(xian)保(bao)(bao)費(fei)(fei)收入(ru)占總保(bao)(bao)費(fei)(fei)的(de)(de)(de)比(bi)(bi)例一般要在(zai)(zai)30％左右。商(shang)業(ye)健康(kang)(kang)(kang)保(bao)(bao)險(xian)在(zai)(zai)醫(yi)(yi)療保(bao)(bao)障(zhang)體(ti)系中(zhong)的(de)(de)(de)比(bi)(bi)重較(jiao)小(xiao)，與(yu)居(ju)民對(dui)健康(kang)(kang)(kang)保(bao)(bao)障(zhang)的(de)(de)(de)需求還有(you)很大(da)的(de)(de)(de)差距(ju)。

市(shi)(shi)(shi)場(chang)(chang)潛力(li)與市(shi)(shi)(shi)場(chang)(chang)風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)矛(mao)盾(dun)：風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)控(kong)制(zhi)(zhi)(zhi)(zhi)薄(bo)弱制(zhi)(zhi)(zhi)(zhi)約健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)的(de)(de)(de)(de)(de)發展(zhan)規(gui)模。健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)一直面(mian)臨(lin)著市(shi)(shi)(shi)場(chang)(chang)潛力(li)巨大(da)和(he)風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)控(kong)制(zhi)(zhi)(zhi)(zhi)薄(bo)弱的(de)(de)(de)(de)(de)矛(mao)盾(dun)。健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)發展(zhan)的(de)(de)(de)(de)(de)風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)環境非常(chang)復雜(za)，除了(le)國外(wai)經(jing)(jing)營健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)都(dou)會面(mian)臨(lin)的(de)(de)(de)(de)(de)醫(yi)(yi)療費用上漲風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)、投保(bao)(bao)人和(he)被(bei)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)人的(de)(de)(de)(de)(de)逆(ni)選(xuan)擇和(he)道(dao)德風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)、醫(yi)(yi)療服(fu)務提供者(zhe)的(de)(de)(de)(de)(de)道(dao)德風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)等風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)因素(su)外(wai)，我國健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)發展(zhan)還面(mian)臨(lin)特有的(de)(de)(de)(de)(de)體(ti)(ti)制(zhi)(zhi)(zhi)(zhi)性風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)，如(ru)(ru)衛生體(ti)(ti)制(zhi)(zhi)(zhi)(zhi)、醫(yi)(yi)療體(ti)(ti)制(zhi)(zhi)(zhi)(zhi)以(yi)及藥(yao)品流通體(ti)(ti)制(zhi)(zhi)(zhi)(zhi)帶來的(de)(de)(de)(de)(de)風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)等。風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)控(kong)制(zhi)(zhi)(zhi)(zhi)成(cheng)為制(zhi)(zhi)(zhi)(zhi)約健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)潛在(zai)需(xu)求轉化為現實(shi)需(xu)求的(de)(de)(de)(de)(de)瓶頸。所有壽險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)公(gong)司(si)都(dou)看到了(le)健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)市(shi)(shi)(shi)場(chang)(chang)蘊含(han)的(de)(de)(de)(de)(de)無(wu)限商(shang)機，但(dan)出(chu)于對(dui)(dui)醫(yi)(yi)療費用失控(kong)風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)的(de)(de)(de)(de)(de)憂慮，誰(shui)也不敢在(zai)這(zhe)個充(chong)滿風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)的(de)(de)(de)(de)(de)市(shi)(shi)(shi)場(chang)(chang)中盲目冒進，兩(liang)者(zhe)遂(sui)產生了(le)矛(mao)盾(dun)。面(mian)對(dui)(dui)如(ru)(ru)此誘人的(de)(de)(de)(de)(de)市(shi)(shi)(shi)場(chang)(chang)前景，保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)公(gong)司(si)卻(que)似乎(hu)顯(xian)得無(wu)動于衷，盡管市(shi)(shi)(shi)場(chang)(chang)上時常(chang)有新的(de)(de)(de)(de)(de)健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)種(zhong)推出(chu)，但(dan)銷(xiao)售規(gui)模未有質(zhi)的(de)(de)(de)(de)(de)突破。因此，如(ru)(ru)何(he)理順保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)公(gong)司(si)、醫(yi)(yi)療服(fu)務提供者(zhe)和(he)被(bei)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)人的(de)(de)(de)(de)(de)關(guan)系有效避(bi)免道(dao)德風(feng)(feng)(feng)(feng)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)。降低醫(yi)(yi)療費用，實(shi)現健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)參與者(zhe)三方和(he)諧“共贏(ying)”，也是健(jian)康(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)(xian)企業經(jing)(jing)營繞(rao)不過去的(de)(de)(de)(de)(de)坎兒。

2.商業健(jian)康保險的作用(yong)未得到充分發揮。我國(guo)社會(hui)醫療保險體系的制度設計(ji)在一(yi)定程(cheng)度上(shang)使(shi)得政府(fu)介入較(jiao)深(shen)，降低了商業保險的發展空間(jian)。主(zhu)要表現在政府(fu)在健(jian)康保險體系中的“越位(wei)(wei)”與(yu)“缺位(wei)(wei)”。

政府(fu)的(de)(de)(de)(de)“越位”主(zhu)要(yao)表現(xian)在。大部(bu)分地(di)區在基本(ben)健(jian)(jian)康(kang)(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)的(de)(de)(de)(de)層面(mian)上(shang)(shang)又(you)舉(ju)辦(ban)形(xing)式(shi)不(bu)同的(de)(de)(de)(de)補(bu)充(chong)(chong)(chong)健(jian)(jian)康(kang)(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)，這(zhe)種由(you)社會(hui)保(bao)(bao)障部(bu)門通(tong)過強制(zhi)參保(bao)(bao)、以基本(ben)健(jian)(jian)康(kang)(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)的(de)(de)(de)(de)方式(shi)來(lai)經營(ying)的(de)(de)(de)(de)補(bu)充(chong)(chong)(chong)健(jian)(jian)康(kang)(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)，從體制(zhi)上(shang)(shang)很難(nan)判定其盈利(li)性(xing)與否。如果說補(bu)充(chong)(chong)(chong)健(jian)(jian)康(kang)(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)舉(ju)辦(ban)的(de)(de)(de)(de)目的(de)(de)(de)(de)在于盈利(li)，則有悖于政府(fu)部(bu)門的(de)(de)(de)(de)職能(neng)；如果說補(bu)充(chong)(chong)(chong)健(jian)(jian)康(kang)(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)舉(ju)辦(ban)目的(de)(de)(de)(de)是非盈利(li)性(xing)，則無異于基本(ben)健(jian)(jian)康(kang)(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)在量上(shang)(shang)的(de)(de)(de)(de)擴張，導致資(zi)金管(guan)理上(shang)(shang)的(de)(de)(de)(de)困難(nan)和(he)(he)政府(fu)部(bu)門人(ren)力成本(ben)的(de)(de)(de)(de)加(jia)大。其次是財政負擔(dan)和(he)(he)企業負擔(dan)的(de)(de)(de)(de)加(jia)大。未來(lai)健(jian)(jian)康(kang)(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)費用的(de)(de)(de)(de)增(zeng)長趨勢與政府(fu)收(shou)費的(de)(de)(de)(de)穩定性(xing)之間的(de)(de)(de)(de)矛盾(dun)難(nan)以克服，現(xian)行收(shou)費的(de)(de)(de)(de)比(bi)例可能(neng)不(bu)足(zu)以應付(fu)未來(lai)的(de)(de)(de)(de)支付(fu)。一旦出(chu)現(xian)補(bu)充(chong)(chong)(chong)健(jian)(jian)康(kang)(kang)(kang)保(bao)(bao)險(xian)(xian)(xian)賬戶資(zi)金不(bu)足(zu)，難(nan)免出(chu)現(xian)向其他賬戶透支而(er)導致資(zi)金管(guan)理混(hun)亂(luan)、或由(you)財政墊付(fu)而(er)增(zeng)加(jia)財政的(de)(de)(de)(de)負擔(dan)、或給付(fu)不(bu)及時而(er)影響整個社會(hui)保(bao)(bao)障體系和(he)(he)政府(fu)的(de)(de)(de)(de)信譽。

三(san)、促進(jin)我國(guo)健康保險發(fa)展的對策

1.健康保險應專業(ye)化經(jing)營(ying)

健康保險(xian)與其(qi)他險(xian)種相比，其(qi)在理賠、核(he)算方面有獨特(te)之處，這(zhe)就需(xu)要專業化的經營才能(neng)保證其(qi)健康有序迅捷的發展。這(zhe)樣的專業化主要體現在以(yi)下幾個方面：

專業化的(de)(de)人(ren)(ren)才(cai)(cai)：保(bao)險作為一(yi)(yi)個(ge)專業性(xing)很(hen)(hen)強(qiang)的(de)(de)金融(rong)產品(pin)，其對從(cong)業人(ren)(ren)員的(de)(de)綜合素質都有很(hen)(hen)高(gao)的(de)(de)要(yao)求。針對健康(kang)保(bao)險，這種專業性(xing)會體現(xian)得更明(ming)顯，對于(yu)醫學、法律人(ren)(ren)才(cai)(cai)的(de)(de)需求缺口，一(yi)(yi)直是(shi)困擾我國健康(kang)保(bao)險行業發(fa)(fa)展的(de)(de)阻礙。由于(yu)健康(kang)保(bao)險的(de)(de)特(te)殊(shu)性(xing)、不確定(ding)性(xing)會給承(cheng)保(bao)理賠帶(dai)來(lai)(lai)很(hen)(hen)大(da)的(de)(de)風險。由于(yu)不確定(ding)性(xing)對于(yu)一(yi)(yi)個(ge)特(te)定(ding)的(de)(de)人(ren)(ren)群(qun)來(lai)(lai)說，某種疾病(bing)的(de)(de)發(fa)(fa)病(bing)概率或許可以通過(guo)科學方(fang)法進行預(yu)測(ce)；但對于(yu)個(ge)人(ren)(ren)來(lai)(lai)說，是(shi)否(fou)會發(fa)(fa)病(bing)卻很(hen)(hen)難估計，疾病(bing)的(de)(de)突發(fa)(fa)性(xing)和隨(sui)機性(xing)，決定(ding)了醫療服務消(xiao)費的(de)(de)不確定(ding)性(xing)。因此，專業化的(de)(de)人(ren)(ren)才(cai)(cai)培養應是(shi)健康(kang)保(bao)險發(fa)(fa)展的(de)(de)重(zhong)要(yao)條件。

專(zhuan)業(ye)(ye)化的(de)(de)管理(li)：根(gen)據健(jian)(jian)康保險(xian)(xian)的(de)(de)經(jing)營特點，專(zhuan)業(ye)(ye)銷(xiao)(xiao)售既是市場拓展的(de)(de)重要手(shou)段，又是風險(xian)(xian)控制(zhi)的(de)(de)有(you)(you)效措施。在專(zhuan)業(ye)(ye)銷(xiao)(xiao)售隊伍尚未(wei)建立以前，健(jian)(jian)康保險(xian)(xian)專(zhuan)業(ye)(ye)銷(xiao)(xiao)售部門可(ke)依托規章制(zhi)度(du)和管理(li)辦法(fa)，實行銷(xiao)(xiao)售風險(xian)(xian)控制(zhi)，操作(zuo)上可(ke)借助公司現有(you)(you)的(de)(de)銷(xiao)(xiao)售渠道。

2.加強社會健康保險與商業(ye)健康保險的協調與整合