中国医疗保障体系的碎片化及其治理之道

发布时间：2018-02-03 08:53

本文关键词： 基本医疗保障体系医保碎片化全民公费医疗社会医疗保险　出处：《学海》2017年01期 　论文类型：期刊论文

【摘要】：由于制度结构的差异性和行政管理的地方性,中国基本医疗保障体系呈现碎片化,致使医保的游戏规则在不同地区、不同身份的人群之间存在着复杂的差别,导致严重的制度失调和运转不良。医保碎片化,无论是从公平还是从效率的角度来衡量,都给中国社会保障事业的发展带来深远的负面影响。医保体系中的诸多老大难问题,例如城乡一体化、统筹层次提高、个人账户的使用及其存废、医保基金累计结余的最优规模及其使用、退休者免缴费规则、医保关系跨地区转移接续(即可携带性)等,均为医保碎片化所累而迟迟难以解决。零碎的制度微调已经无济于事,中国医保亟需系统性的改革。从社会医疗保险向全民公费医疗转型,是最合意的方向。在转型期,实行介于社会医疗保险和全民公费医疗之间的准全民公费医疗(或称"全民健康保险"),是一条可行的医保改革路径。
[Abstract]:Because of the difference of system structure and the locality of administration, the basic medical security system in China is fragmented, which leads to the complex difference of the game rules of medical insurance in different regions and groups of people of different status. It leads to serious institutional maladjustment and malfunctioning. Health care is fragmented, measured in terms of fairness and efficiency. For example, the integration of urban and rural areas, the improvement of the overall level, the use of personal accounts and their retention. The optimal scale of the cumulative balance of the medical insurance fund and its use, the non-payment rules of retirees, the transregional transfer of the medical insurance relationship (i.e. portability) and so on. The piecemeal medical insurance system has been piecemeal and difficult to solve. The piecemeal system adjustment is no longer helpful. China's health care needs systematic reform. The transformation from social health insurance to public health care. In the transition period, it is feasible to implement the quasi-universal public health care (or "national health insurance") between social medical insurance and public health care.
【作者单位】：北京大学政府管理学院;
【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”(项目号:15 ZDA050)的阶段性成果
【分类号】：F842.684
【正文快照】： 在当今中国,一个覆盖全民的基本医疗保障体系已经建立起来。基本医疗保障体系的建立是中国新一轮医药卫生体制改革(以下简称“新医改”)的成就之一。2009年4月6日,《中共中央国务院关于深化医药卫生体制改革的意见》(以下简称“新医改方案”)公布,正式拉开了“新医改”的序幕

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