我国推进基本医疗保险省级统筹,需要结合各省实际寻找切实可行的路径。本研究在分析部分省份实施路径的基础上,提出存在水平公平和垂直公平两种省级统筹模式。选取一个具有代表性的省份,以职工医保为研究对象,通过现状调查、政策梳理、数据分析以及评估论证,对两种模式进行对比分析后,认为相对水平公平,基于垂直公平的省级统筹模式更适合地市间差异较大的省份。本研究重点探讨基于垂直公平的省级统筹实现路径,深入系统地介绍了调剂金提取和分配办法以及相关要素,并提出实施过程中可能遇到的问题以及相关对策和建议,供各地参考借鉴。

To promote the provincial pooling of basic medical insurance, it is necessary to find a feasible way according to the situation of each province. Based on the analysis of the implementation paths of some provinces, this study proposes that there are two pooling modes of provincial pooling, i.e. horizontal equity and vertical equity. A representative province is selected to take employees’ medical insurance as the research object. After comparing and analyzing the two modes through current situation investigation, policy summary, data analysis and evaluation, it is concluded that compared to horizontal equity, the provincial pooling mode based on vertical equity is more suitable for provinces with large differences between cities. This study focuses on the implementation path of provincial pooling based on vertical equity, introduces the adjustment fund extraction and allocation methods and related factors systematically, and puts forward the problems that may be encountered in the implementation process, as well as relevant countermeasures and suggestions for reference.