我国医疗保险制度发展四十年:进程、经验与展望
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摘要
我国医疗保险制度自改革开放以来经历了从试点探索到覆盖全体国民的发展过程,并以新一轮医药卫生体制改革为背景和契机进行了深入发展和完善。基于改革开放40年医疗保险发展道路的回顾,可以发现:我国医疗保险制度积累了保障对象由少到多、制度类型从分割到整合、保障能力从低到高、管理效率从粗放到精细化、改革路径从孤立到协同等发展经验;但同时也仍然存在着公平性有待提升、制度定位不清、权责不明、医保在医药卫生体系中的功能发挥不够充分等问题。在健康中国全民共建共享的战略主题和目标导向下,构建起更加公平可持续的全民医保制度的举措包括制度保障更加公平、医保体系更加完善、筹资机制更加合理、管理服务更加高效、改革路径更加协同等。
Since the reform and opening up,China's health insurance system has experienced a development process from pilot exploration to covering all citizens,which also carried out new improvement with the background and opportunity of the new medical and health system reform.Based on the review of the development path of health insurance for 40 years since the reform and opening up,this paper finds that the health insurance system's development has some experiences such as objects people from less to more,system types from segmentation to integration,medical insurance standard from lower to higher,medical insurance management from extensive to fine,and reform method for medical insurance from individual to coordination.However,there are still some problems in the health insurance system such as fairness needing improving,the unclear positioning of the institution,unclear rights and responsibilities,and the inadequate functioning of medical insurance in the medical and health system.Under the guidance and strategic themes of healthy China,the path of building a more fair and sustainable universal health insurance system includes a more fair and complete medical insurance system,a more reasonable financing mechanism,a more efficient management services and a more systematic reform way.
Since the reform and opening up,China's health insurance system has experienced a development process from pilot exploration to covering all citizens,which also carried out new improvement with the background and opportunity of the new medical and health system reform.Based on the review of the development path of health insurance for 40 years since the reform and opening up,this paper finds that the health insurance system's development has some experiences such as objects people from less to more,system types from segmentation to integration,medical insurance standard from lower to higher,medical insurance management from extensive to fine,and reform method for medical insurance from individual to coordination.However,there are still some problems in the health insurance system such as fairness needing improving,the unclear positioning of the institution,unclear rights and responsibilities,and the inadequate functioning of medical insurance in the medical and health system.Under the guidance and strategic themes of healthy China,the path of building a more fair and sustainable universal health insurance system includes a more fair and complete medical insurance system,a more reasonable financing mechanism,a more efficient management services and a more systematic reform way.
引文
(1)胡晓义主编:《走向和谐:中国社会保障发展60年》,北京:中国劳动社会保障出版社,2009年,第190-191页。
(2)国务院新闻办公室:《中国健康事业的发展与人权进步》白皮书,2017年。
(3)仇雨临、翟绍果、黄国武:《大病保险发展构想:基于文献研究的视角》,《山东社会科学》2017年第4期。
(4)人社部就跨省异地就医直接结算工作进行政策解读,http://www.mohrss.gov.cn/yiliaobxs/YILIAOBXSgongzuodongtai/201710/t20171017_279361.html
(5)仇雨临、王昭茜:《全民医保与健康中国:基础、纽带和导向》,《西北大学学报(哲学社会科学版)》2018年第3期。
(6)李岚清:《全面推进医药卫生体制改革,让职工群众享有更好医疗服务》,《人民日报》2001年1月5日第一版。
(7)仇雨临:《回顾与展望:构建更加公平可持续的全民医保体系》,《江淮论坛》2016年第1期。
(8)何文炯:《建设更加公平可持续的医疗保障制度》,《中国行政管理》2014年第7期。
(9)王东进:《完善全民医保促进全民健康》,《中国医疗保险》2017年第3期。
(10)郑功成:《健康中国建设与全民医保制度的完善》,《学术研究》2018年第1期。
(2)国务院新闻办公室:《中国健康事业的发展与人权进步》白皮书,2017年。
(3)仇雨临、翟绍果、黄国武:《大病保险发展构想:基于文献研究的视角》,《山东社会科学》2017年第4期。
(4)人社部就跨省异地就医直接结算工作进行政策解读,http://www.mohrss.gov.cn/yiliaobxs/YILIAOBXSgongzuodongtai/201710/t20171017_279361.html
(5)仇雨临、王昭茜:《全民医保与健康中国:基础、纽带和导向》,《西北大学学报(哲学社会科学版)》2018年第3期。
(6)李岚清:《全面推进医药卫生体制改革,让职工群众享有更好医疗服务》,《人民日报》2001年1月5日第一版。
(7)仇雨临:《回顾与展望:构建更加公平可持续的全民医保体系》,《江淮论坛》2016年第1期。
(8)何文炯:《建设更加公平可持续的医疗保障制度》,《中国行政管理》2014年第7期。
(9)王东进:《完善全民医保促进全民健康》,《中国医疗保险》2017年第3期。
(10)郑功成:《健康中国建设与全民医保制度的完善》,《学术研究》2018年第1期。