公平视角下中国社会医疗保险多轨制差异研究

发布时间：2019-05-23 22:05

【摘要】：“病有所医”是人类社会文明进步的标志,完善的医疗保障制度是现代公民社会实现“病有所医”的根本途径。我国的社会医疗保险制度体系自建立以来在满足公民医疗需求、保障公民健康权利方面发挥了重要作用,经过长期的探索与发展,截至目前,已经形成了以公务员医疗保险制度(名义上划归城镇职工基本医疗保险制度)、职工基本医疗保险制度、城镇居民基本医疗保险制度和新型农村合作医疗制度为支撑的多轨制医保制度体系,并基本实现了医保全覆盖。然而,现行的多轨制医疗保险制度之间差异巨大,公平性问题突出,制约了医保作用的发挥与“病有所医”的全面实现。本文以医疗保障的公平观为基础,从“显性公平”和“隐性公平”两个维度出发,具体围绕参保机会、医保缴费、基金统筹与支出、保障范围、给付水平、信息对称性、附加成本支出、行政服务质量、医疗资源配置和实际保障效果等指标,基于文献研究与实地研究两种方法对公务员医疗保险制度、职工基本医疗保险制度、城镇居民基本医疗保险制度和新型农村合作医疗制度进行了考察,对各类制度之间的差异进行了比较分析并对其背后的公平性进行了探究。通过比较研究发现,我国现行多轨制医保制度之间差异巨大,公平性问题突出。公务员医保制度在待遇水平远超其他三类制度；职工医保水平整体上处于中等偏上,医保待遇优于城镇居民医保和新型农村合作医疗,但与公务员相比仍存在较大差距；城镇居民医保在框架上参照城镇职工医保设计,与前两者并称为城镇基本医疗保险制度,但保障水平整体上看要低于前者,位于中等偏下；新型农村合作医疗制度是四类医保制度中覆盖人口最广的,但同时其保障水平总体而言也是四类制度中最低的,与其他三类制度差距较大。基于以上结论,本文从国民医疗需求的满足、社会公平正义、医疗资源的利用效率,社会的和谐稳定、医保制度运行成本、改革统筹难度、医保作用发挥、劳动力配置与社会流动等方面入手讨论了医保多轨制差异过大、公平性缺失现状带来的影响。并围绕历史局限、基本国情、户籍制度和权利博弈等方面对医保多轨制现状差异的成因进行了分析,在此基础上对我国医保的改革路径进行了探索,提出通过“四三二一”的并轨改革提高统筹层次,推动医保待遇的一元化的改革建议。
[Abstract]:"Hospital for illness" is a symbol of the civilization and progress of human society, and a perfect medical security system is the fundamental way to realize "medical treatment" in modern civil society. Since the establishment of the social medical insurance system in our country, it has played an important role in meeting the medical needs of citizens and ensuring the health rights of citizens. After a long period of exploration and development, up to now, The medical insurance system for civil servants (nominally classified as the basic medical insurance system for urban workers) and the basic medical insurance system for workers and workers have been formed. The multi-track medical insurance system supported by the basic medical insurance system for urban residents and the new rural cooperative medical system has basically realized the full coverage of medical insurance. However, there are great differences between the current multi-track medical insurance system, and the fairness problem is prominent, which restricts the function of medical insurance and the overall realization of "medical care". Based on the fair view of medical security, starting from the two dimensions of "explicit fairness" and "implicit fairness", this paper focuses on the participation opportunity, medical insurance payment, fund overall planning and expenditure, guarantee scope, payment level and information symmetry. The additional cost expenditure, the quality of administrative service, the allocation of medical resources and the actual security effect are based on the two methods of literature research and field research on the medical insurance system of civil servants and the basic medical insurance system of staff and workers. The basic medical insurance system of urban residents and the new rural cooperative medical system are investigated, the differences among various systems are compared and analyzed, and the fairness behind them is explored. Through the comparative study, it is found that there are great differences between the current multi-track medical insurance system in China, and the fairness problem is prominent. The treatment level of civil service medical insurance system is much higher than that of the other three kinds of systems. On the whole, the level of medical insurance for workers is above the middle level, and the treatment of medical insurance is better than that of urban residents' medical insurance and the new rural cooperative medical system, but there is still a big gap compared with the civil servants. The medical insurance of urban residents refers to the design of medical insurance for urban workers in the framework, which is called the basic medical insurance system of cities and towns, but the level of security is lower than that of the former as a whole and is in the lower middle. The new rural cooperative medical system is the most widely covered by the four types of medical insurance system, but at the same time, its security level is also the lowest among the four types of systems, which is quite different from the other three types of systems. Based on the above conclusions, this paper focuses on the satisfaction of national medical needs, social fairness and justice, the efficiency of the use of medical resources, the harmony and stability of society, the operating costs of the medical insurance system, the difficulty of reform and overall planning, and the role of medical insurance. This paper discusses the influence of excessive differences in multi-track system of medical insurance and lack of fairness in the aspects of labor allocation and social mobility. Based on the historical limitations, basic national conditions, household registration system and rights game, this paper analyzes the causes of the differences in the current situation of medical insurance multi-track system, and on this basis, probes into the reform path of medical insurance in our country. This paper puts forward some suggestions to improve the level of overall planning and promote the unification of medical insurance treatment through the reform of "four, three, two, one".
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.1;F842.684

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