基本医疗保险保得越多越好吗?
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摘要
我国基本医疗保险制度的特点是高覆盖率、高保障度,但实践中却存在政策失灵问题。一是较大程度脱离我国经济发展而保得过多、过高,面临着保不起、保不好的压力;二是作为引导和调控参保人住院选择的住院起步费、支付比例及其步差,作用发挥不大,住院率居高不下,统筹基金支出过大;三是政策设计和运行监管不完善,存在过度医疗和不公平享用问题等。政策的目标达成度与设计初衷存在较大差距,影响制度自身正常运行和可持续发展。因此要改进和完善相关政策,更加注重制度的效率和效益。
The basic medical insurance system in China is characterized by high coverage and high security, but there is a policy failure. Firstly, the medical insurance system does not match the economic development level of our country.There is too much to be insured. The high expense brings great pressure to our country. Secondly, the start fee, payment proportion and step difference of the hospitalization that are expected to guide and regulate the hospitalization selection of the insured do not play an active role. The hospitalization rate remains high and the planned funds are still overburdened.Thirdly, policy design and supervision are not so perfect that there are still unsolved problems of excessive medical treatment and unfair accessibility. There is a big gap between the goal-reaching degree of the policy and the original intention of policy design. We should improve relevant policies and pay more attention to the efficiency and effectiveness of the medical insurance system.
The basic medical insurance system in China is characterized by high coverage and high security, but there is a policy failure. Firstly, the medical insurance system does not match the economic development level of our country.There is too much to be insured. The high expense brings great pressure to our country. Secondly, the start fee, payment proportion and step difference of the hospitalization that are expected to guide and regulate the hospitalization selection of the insured do not play an active role. The hospitalization rate remains high and the planned funds are still overburdened.Thirdly, policy design and supervision are not so perfect that there are still unsolved problems of excessive medical treatment and unfair accessibility. There is a big gap between the goal-reaching degree of the policy and the original intention of policy design. We should improve relevant policies and pay more attention to the efficiency and effectiveness of the medical insurance system.
引文
[1]赵大海,谷书丽.公共服务机构的公益性运行特征与必要条件:15个发达国家基层医疗卫生系统的经验及对我国的启示[J].上海交通大学学报:哲学社会科学版,201826(2):16-24.
[2]蒋云赟,刘剑.我国统筹医疗保险体系的财政承受能力研究[J].财经研究,2015,41(12):4-14.
[3]匡列辉.新时代“共享”发展理路及其世界意义[J].理论月刊,2018(2):18-23.
[4]刘胜良.外资独资医院的伦理风险及规避策略[J].医学争鸣,2017,8(1):69-72,75.
[5]肖云芳,杨小丽.我国分级诊疗的实施困境及对策建议[J].医学争鸣,2017,8(5):49-52.
[6]刘浩然,汤少梁.信息不对称条件下医疗服务市场主体间的博弈关系分析[J].医学与社会,2016,29(4):14-16,23
[7]成志刚,唐沙.我国医疗服务供给侧改革的场景与路径[J].湘潭大学学报:哲学社会科学版,2017,41(4)28-33.
[8]马桂峰,盛红旗,张婷,等.社会医疗保险基金收支平衡与风险评估研究[J].中国卫生经济,2017,36(7):25-27.
[9]成昌慧,陈丽艳,孙璇,等.城乡居民基本医疗保险筹资政策研究--以济南市为例[J].中国初级卫生保健,2015,29(8):13-16.
[10]胡大洋.革除分级诊疗的体制弊端[J].中国医疗保险2017(5):5-9.
[11]廖祖达,邵建华,陈澍,等.上海医保监管的法治创新与实施成效[J].中国医疗保险,2016(8):42-45.
[12]郑功成.健康中国建设与全民医保制度的完善[J].学术研究,2018(1):76-83,177.
[2]蒋云赟,刘剑.我国统筹医疗保险体系的财政承受能力研究[J].财经研究,2015,41(12):4-14.
[3]匡列辉.新时代“共享”发展理路及其世界意义[J].理论月刊,2018(2):18-23.
[4]刘胜良.外资独资医院的伦理风险及规避策略[J].医学争鸣,2017,8(1):69-72,75.
[5]肖云芳,杨小丽.我国分级诊疗的实施困境及对策建议[J].医学争鸣,2017,8(5):49-52.
[6]刘浩然,汤少梁.信息不对称条件下医疗服务市场主体间的博弈关系分析[J].医学与社会,2016,29(4):14-16,23
[7]成志刚,唐沙.我国医疗服务供给侧改革的场景与路径[J].湘潭大学学报:哲学社会科学版,2017,41(4)28-33.
[8]马桂峰,盛红旗,张婷,等.社会医疗保险基金收支平衡与风险评估研究[J].中国卫生经济,2017,36(7):25-27.
[9]成昌慧,陈丽艳,孙璇,等.城乡居民基本医疗保险筹资政策研究--以济南市为例[J].中国初级卫生保健,2015,29(8):13-16.
[10]胡大洋.革除分级诊疗的体制弊端[J].中国医疗保险2017(5):5-9.
[11]廖祖达,邵建华,陈澍,等.上海医保监管的法治创新与实施成效[J].中国医疗保险,2016(8):42-45.
[12]郑功成.健康中国建设与全民医保制度的完善[J].学术研究,2018(1):76-83,177.