全民基本医保一体化的实现路径分析——基于筹资水平的视角

发布时间：2018-04-12 20:56

本文选题：健康权 + 基本医疗保险　；参考：《经济社会体制比较》2017年06期

【摘要】：基本医疗保险作为维护健康权这一基本人权的主要制度,是一个提供起点公平的制度,与其他社会保险不同,它的核心价值观是"平等"。到21世纪中叶实现全民统一的、保障水平适度的基本医疗保险制度已成政学两界的共识,有分歧的是关于实现目标的路径。当前主流观点和多地的试点政策主张的是走先合并城乡居民医保再考虑合并居民医保和职工医保的"居民—职工"模式。基于人均筹资是否能基本实现均等化的模拟分析表明,此模式下居民制度和职工制度在人均筹资上的绝对差距只会越来越大,一体化之路几无可能。如若以退为进,选择基于常住地参保、家庭联保、强制参保原则的,先实现城镇内部诸制度一体化,同时改革完善新农合制度,进而顺时顺势实现城乡制度自然融合的"城镇—农村"模式,则不仅全民基本医保一体化的目标可以实现,同时还可达成优化医疗卫生体制、助推城镇化进程的正外部效应。
[Abstract]:As the main system of safeguarding the right to health, the basic medical insurance is a system that provides a fair starting point. Unlike other social insurance, its core value is "equality".By the middle of the 21st century, the basic medical insurance system, which is unified by the whole people and with a moderate level of security, has become the consensus of the two circles of politics, but what is different is the way to achieve the goal.At present, the mainstream view and the pilot policy of many places advocate the "inhabitant-worker" mode of merging urban and rural residents' medical insurance first and then considering the combination of residents' medical insurance and employee's medical insurance.The simulation analysis based on whether per capita financing can basically achieve equalization shows that the absolute gap between resident system and worker system in per capita financing will only become larger and larger under this model, and the road of integration is almost impossible.If we take retreat as a step forward and choose the principle of permanent residence insurance, family protection, and compulsory insurance, we should first realize the integration of various systems within the town, and at the same time reform and perfect the new rural cooperative system.Then the "urban-rural" mode of natural integration of urban and rural systems can be realized in a timely and favorable manner, which can not only achieve the goal of the integration of basic health insurance for all people, but also achieve the positive external effects of optimizing the medical and health system and promoting the process of urbanization.
【作者单位】：中国人民大学公共管理学院;中国人民大学社会保障研究所;中国人民大学健康保障研究中心;
【基金】：国家社会科学基金重点项目“建立公平可持续的老年收入保障体系研究”(项目编号:15AJL012)
【分类号】：F842.684

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