摘要
中国城镇职工基本医疗保险个人账户建立以来始终面临存废之争。理论分析显示,个人账户的基本假定存在内在缺陷,也与外部的医疗卫生体系制度环境格格不入。在中国的政策实践中,个人账户的缺陷表现得淋漓尽致,改革个人账户势在必行。在各种改革方案中,不再建立个人账户,用个人账户资金将职工家属纳入职工医疗保险,实行以家庭为单位参保的家庭联保改革方案是最优路径。家庭联保改革可以增强基本医疗保险制度的强制性,解决城镇家庭一家多制现象,化解城镇家庭医疗费用后顾之忧;可以让政府财政专注于补贴职工及其家属以外的国民,解决政府长期补贴绝大部分国民的制度困境;可以激励农民工及其家属参加职工医疗保险,加速国家城镇化战略的推进。随着中国城镇化水平不断提高,在不远的未来职工及其家属医疗保险和城乡居民医疗保险,将因筹资水平日趋接近而自然融合为全民统一的国民健康保险制度。
The system of individual account of basic medical insurance for urban workers in china,since the day it was set up,has been in dispute.This paper theoretically proves that the basic assumptions of individual account are inherently defective and incompatible with the external medical system environment.In practice,the defects of the system are easily-seen and thus a reform is imperative.Among all the reform proposals,a joint-insurance on a family basis is the optimal path,which means the individual account will be abolished and the family members of the insured workers will also be included within the workers'medical insurance,using the individual account funds.This reform path could enhance the compulsory administration of the basic medical insurance system so as to avoid multiple systems for urban households,thus reducing the risks of medical expenses for urban family.Meanwhile,it allows the government to focus on subsidizing all the rest citizens other than just workers and their family members,which could pave a way to solve the institutional predicament of the government's long-term subsidies for most of the citizens.It could further encourage migrant workers and their family members to participate in workers'medical insurance and propel the practice of national urbanization strategy.With the deepening practice of urbanization,the workers'medical insurance on a family basis and the medical insurance system for urban and rural residents will achieve a natural integration in the near future due to the close convergence of funding and benefit levels.
作者
王超群
李珍
WANG Chaoqun;LI Zhen
出处
《华中农业大学学报（社会科学版）》
CSSCI
北大核心
2019年第2期27-37,164,共12页
Journal of Huazhong Agricultural University(Social Sciences Edition)
基金
国家社会科学基金青年项目"中国灾难性卫生支出风险管理机制研究"(15CGL047)
关键词
医疗保险
个人账户
制度性缺陷
改革路径
家庭联保
medical insurance
individual account
institutional defects
reform path
joint-insurance on a family basis
