摘要 目的：了解健康体检纳入基本医疗保险的必要性，了解上海市职工和城乡居民健康体检的利用和费用情况，以及上海市基本医疗保险基金的收支和结余情况，对健康体检纳入基本医疗保险进行预算影响分析，从而探讨可行性。方法：运用文献研究法对健康体检纳入医疗保险的必要性进行研究，运用调查法、描述性研究法对上海市健康体检费用，医疗保险基金结余以及二者关系进行分析。结果：将健康体检纳入上海市城镇职工基本医疗保险后，按100%的比例报销，上海市城镇职工基本医疗保险当年收支结余为171.10亿元且累计结余为2241亿元，如果报销比例降低，当年收支结余和累计结余都会增加；将健康体检纳入上海市城镇居民基本医疗保险后即便按照10%的比例报销，上海市城镇居民医疗保险基金当年收支结余为-3.70亿元，且累计结余为1.10亿元。结论：可以将上海市城镇职工健康体检费用纳入基本医疗保险，不建议将城镇居民健康体检费用纳入基本医疗保险。

关键字：健康体检；纳入；基本医疗保险；可行性

The Feasibility Study of Shanghai Health Examination  into Basic Medical Insurance

Abstract:  Objectives: Analyze the necessity of incorporating health insurance into health insurance, understand the utilization and cost of health checkups for Shanghai employees and urban and rural residents, and the status of income and expenditures and balances of the Shanghai Medical Insurance Fund. Analyze the inclusion of health check-ups into medical insurance for funds, and explore feasibility. Methods: The literature research method was used to study the necessity of incorporating health insurance into medical insurance, and the investigation method and descriptive research method were used to analyze the health checkup costs, medical insurance fund balances, and the relationship between them. Results: The health check will be included in the basic medical insurance for urban workers in Shanghai and will be reimbursed at a rate of 100%. The balance of basic medical insurance for urban employees in Shanghai is 17.11 billion yuan in the year, and the cumulative balance is 224.1 billion yuan. If the proportion of reimbursement is reduced, the current balance of payments and accumulated balance will increase. After the health check was included in the basic medical insurance for urban residents in Shanghai, even if it was reimbursed at a rate of 10%, the balance of income and expenditure of Shanghai urban residents' medical insurance fund in the current year was -370 million yuan, and the accumulated surplus was 110 million yuan. Conclusion: It is possible to incorporate health check-up costs for employees of Shanghai enterprises into medical insurance, and it is not recommended to include health check-up costs for urban residents into medical insurance.

Key words：Health examination；Inclusion；basic medical insurance；feasibility

目录

一、绪论 1

（一）研究背景 1

（二）研究目的 2

（三）研究意义 2

二、研究方法 3

（一）健康体检的定义 3

（二）文献研究法 3

（三）数据分析法 5

1、上海市健康体检的利用和费用情况 5

2、上海市医疗保险的收支和结余情况 5

3、将健康体检纳入基本医疗保险的预算影响分析 6

三、研究结果 10

（一）文献研究的结果 10

（二）数据分析的结果 10

四、政策建议 11

结论 12

致谢 13

参考文献 14

一、绪论

（一）研究背景

医保制度这些年，确实减轻了患者医疗负担，很大程度上化解了他们因病致贫、因病返贫的切肤之痛。当然，由于医保资金只是针对已发生疾病在治疗环节的支出，往往被视作“救命钱”，体检自然是被排除在外的，加上大部分人并没有定期体检的意识，这客观上使得一些大病、重病无法早发现、早诊断、早治疗，因而，近些年，将健康体检纳入医保的呼声不时响起。