中国城乡统筹医疗保障制度理论与实证研究  

The Theoretical and Empirical Study on China's System of Medical Insurance by Urban-Rural Integration

作　　者：王红漫[1] 

机构地区：[1]北京大学医学人文研究院,北京100191

出　　处：《北京大学学报（哲学社会科学版）》2013年第5期152-158,共7页Journal of Peking University(Philosophy and Social Sciences)

基　　金：国家哲学社会科学基金重点项目"城乡医疗统筹背景下我国医疗保障体系问题研究"(项目编号:13AGL010)

摘　　要：中国现行基本医保制度是在计划经济向社会主义市场经济过渡中,由劳保医疗、公费医疗、农村合作医疗等制度转变而来;其主要构成部分为城镇职工社会基本医疗保险、新型农村合作医疗、城镇居民医疗保险。三大基本医保的依次建立将中国居民不断纳入到社会医疗保障体系中,在政策上实现了全民覆盖;但是,现行以户籍、行政区划、就业情况为基本考量的三大基本医保已经不能完全适应社会的发展变化,人口老龄化、城乡一体化发展、卫生费用不断增长等,给现行医疗保障制度带来了严峻的挑战和冲击。本研究在实证调查的基础上,通过定义优良性指标和建立模型,提出了开放型医保体系的经费测算模式和实施方法。研究表明,在经济发展水平不同晋辽地区,将三种医疗保险制度转化为统一制度下的三种医疗保障水平,允许居民自由选择,建立开放型医保可以提高百姓满意度,并能节约政府卫生支出,在理论上证明了可以进行帕累托改进,即政府和居民双方的利益都增加,本研究为卫生改革提供了可资参考的新思维逻辑和技术工具。This paper explores the necessities and feasibilities of establishing a system of basic social medical insurance by urban-rural integration in regions whose economic development is at different levels. Based on the survey data in 2011, this paper analyzes and compares the residents＇ willingness to choose medical insurance and its influential demographic characters and calculates the change of government health expenditure after the establishment of the system of medical insurance by urban-rural integration in Liaoning and Shanxi Provinces with the methods of contingency table, linear regression and discriminant analysis. The common demographic characters that influenced the residents＇ choice of medical insurance in the above-mentioned two regions included household, age, commercial insurance, occupation and education. The deductible lines of insurances for working and non-working urban residents were expected to be reduced, and the premium and deductible lines of the new type of rural cooperative medical care system could be increased. Shanxi provincial government could save 10. 9815 billion yuan and Liaoning provincial government could save 3. 6214 billion yuan, if the medical insurances in each region reached the current average level of Beijing Municipality and the residents were allowed to choose medical insurances at their own will. It is necessary and feasible to integrate the current three basic medical insurances into three different levels of medical insurance under a unified system and allow the residents to be free to make choices in the regions where the economic development is at different levels.

关 键 词：城乡统筹 基本医疗保险 线性回归 判别分析 实证研究 理论探讨 

分 类 号：C913.7[经济管理]