走向全民覆盖:金砖五国健保筹资体系的制度与治理变革

发布时间：2018-05-02 00:20

本文选题：普惠健康覆盖 + 金砖国家　；参考：《天津行政学院学报》2017年06期

【摘要】：普惠健康覆盖是衡量健康保障体系发展的新目标。让民众享有一定质量的基本健康服务的同时免于财务风险,即提高健保覆盖率或降低自付率,是实现这一目标的重中之重。在金砖五国中,南非和巴西基于社会医疗保险和私立健康保险的发展,辅之以公立健保和公费医疗,提高了健保体系的筹资水平和公共支出水平,使自付率降低到发达国家的水平。中国通过有效发挥行政治理的作用,提高了公共健保体系的覆盖率,但由于市场机制和社群机制的孱弱,健保体系存在着筹资水平较低以及制度碎片化的问题。俄罗斯和印度的健保体系均以全民公费医疗为基础,辅之以社会医疗保险和公立健康保险,但行政治理的主导未能与市场和社群治理有机整合起来,健保体系呈现出一定的治理失灵,民众自付率较高。
[Abstract]:Universal health coverage is a new goal to measure the development of health protection system. The most important thing to achieve this goal is to provide basic health services of a certain quality without financial risk, that is, to increase the coverage rate of health insurance or to reduce the out-of-pocket payment rate. Among the BRICS countries, South Africa and Brazil, based on the development of social health insurance and private health insurance, supported by public health care and public health care, have increased the level of funding and public expenditure for the health care system. Bring the out-of-pocket rate down to the level of the developed world. China has improved the coverage of the public health insurance system by effectively exerting the role of administrative governance. However, due to the weakness of the market mechanism and the community mechanism, the health insurance system has the problems of low level of financing and fragmentation of the system. Health care systems in Russia and India are based on universal public health care, supplemented by social health insurance and public health insurance, but the dominance of administrative governance has failed to integrate organically with market and community governance. Health care system presents a certain governance failure, the public pay rate is high.
【作者单位】：北京大学;
【基金】：国家社会科学基金重大项目“中国特色现代社会福利制度框架设计研究”(15ZDA050)
【分类号】：F841.684;R197.1

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