论我国基本医疗保险制度建设中的俱乐部壁垒:现状、成因和前景

发布时间：2018-02-25 15:26

本文关键词： 卫生正义公共服务产品均等化基本医疗保险制度俱乐部壁垒公益外溢　出处：《苏州大学学报(哲学社会科学版)》2013年02期 　论文类型：期刊论文

【摘要】：在"以人为本"的科学发展观指导下,根据世界卫生组织"人人享有公平的健康保障"的卫生正义原则,我国在着力打破以身份、户籍和地区为特征的历史形成的城乡二元、地区分割的医疗保障体系,推进公共服务产品均等化,推进建立全国统一的居民基本医疗保险体系。然而,这一建设遭遇到俱乐部壁垒的严重阻碍。长期以来,由于区域间、城乡间、职业间经济发展水平和收入分配水平的严重差别,财税"分灶吃饭"的体制,造成了公共产品的俱乐部化。地方政府、单位、行业都在建立根据自己财力承受能力,确定本位利益最大化的基本医疗保险体系,因而形成了在俱乐部内部的外部性,在俱乐部外部的内部性,形成俱乐部之间难以互通的森严壁垒。以发达地区壁垒为例,一旦需要开放俱乐部,使公益外溢,那么就必然面临承担拯救全国流动人口的"耗散难题"。解决俱乐部壁垒难题,是科学推进我国基本医疗保险制度健康有序发展的关键。
[Abstract]:Under the guidance of "people-oriented" view of scientific development, and according to the principle of health justice of the World Health Organization "everyone has fair health security", our country is trying to break the duality of urban and rural areas formed by the history of identity, household registration and region. The regionalization of the medical security system, the promotion of equalization of public service products, and the establishment of a unified national basic medical insurance system for residents. However, this construction has encountered serious obstacles from the club barrier. For a long time, because of the inter-regional, The serious differences between the level of economic development and income distribution between urban and rural areas and between occupations, and the system of fiscal and taxation "eating according to stoves" have resulted in the clubbing of public goods. Local governments, units, and industries are all building up their financial capacity according to their own means. The basic medical insurance system, which determines the maximization of standard benefits, forms the externality within the club, the internality outside the club, and the severe barriers which are difficult to communicate between clubs. Take the developed region as an example, Once it is necessary to open the club and make the public welfare overflow, it is inevitable to face the "dissipative problem" to save the floating population in the whole country. To solve the club barrier problem is the key to promote the healthy and orderly development of the basic medical insurance system in our country scientifically.
【作者单位】：苏州大学政治与公共管理学院;
【基金】：国家社会科学基金重点项目课题“推进新型农村合作医疗制度改革”(项目编号:10AGL013)的阶段性成果江苏高校优势学科建设工程“地方政府与社会管理”(编号:YX10200111)项目支持
【分类号】：F842.6

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