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.
作者
张嘉佳
张伟
李荣欣
ZHANG Jiajia;ZHANG Wei;LI Rongxin(School of Social and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing 210023, China;Affiliated Hospital of Weifang Medical University, Weifang 261031, China)
出处
《医学争鸣》
CAS
2019年第1期69-72,共4页
Negative
基金
国家自然科学基金(71173158)
关键词
基本医疗保险制度
政策设计
政策目标
达成度
basic medical insurance system
policy design
policy objectives
achievement degree
