发挥基本医保的主体作用 健全职工大病风险分担机制——基于江西省2012年职工医疗保险运行状况  

Playing a Leading Role of the Basic Medical Insurance in Establishing and Perfecting Sharing Mechanism of Catastrophic Illness Risk in the Employees

作　　者：董曙辉[1] 

机构地区：[1]江西省社会保险管理中心,南昌330025

出　　处：《中国医疗保险》2013年第8期9-12,共4页China Health Insurance

摘　　要：本文从大病的费用视角出发,对大病及风险进行定义,运用江西省2012年职工医疗保险运行数据,推算出省职工大病风险费用线和个人大病风险自负能力线,量化出职工大病患者、大病费用的构成及分担状况,得出了基本医保是职工大病风险分担主体的结论。在此基础上,提出了扩大和提高基本医保支付范围和封顶线,合并实施基本医保和大病保险,探索运用基本医保个人账户购买大病保险,合理确定职工个人分担大病风险的责任,落实各项医疗保障制度分担大病风险的责任,完善大病医疗救助和慈善救助制度,发挥基本医保的主体作用,建立健全职工大病风险分担机制的建议。From the perspective of the catastrophic illness cost, this article defines catastrophic illness and its risk, based on 2012 employee medical insurance operation data in Jiangxi Province calculates cost line and personal ability line of catastrophicillness risk for the staffrs in Jiangxi province, calculates catastrophic illness patients and costs and their construction and sharing status for the staffs in Jiangxi province,then reaches the conclusion that the basic medical insurance is the main share of catastrophic illness risk. On the basis of the above,the author puts forward to proposals of expanding and improving the basic medical insurance payment scope and ceiling, mergering the basic medical insurance and catastrophic illness insurance, exploringto purchase serious illness insurance with the basic medical insurance individual accounts, setting reasonable responsibilities of individuals and medical security system in the serious illness risk-sharing, ,improving the function of medical assistance, producing a leading role of the basic medical insurance and perfecting the sharing mechanism of catastrophic illness risk in the staffs.

关 键 词：基本医疗保险 主体作用 大病风险 分担机制 

分 类 号：F842.6[经济管理—保险]