医保制度对重点人群保护机制的国际经验  

Role of health insurance system in protection of a targeted population: International experience

作　　者：金春林[1,2] 李芬[1,2] 王常颖[1,2] 

机构地区：[1]上海市卫生发展研究中心,上海200040 [2]上海市医学科学技术情报研究所,上海200040

出　　处：《中国卫生政策研究》2013年第9期24-28,共5页Chinese Journal of Health Policy

基　　金：上海市财政支持项目(201242500091-10019)

摘　　要：我国医保覆盖面和保障程度在不断提高,但对于重点人群的保护效果却不甚理想。本文简要介绍了德国、日本、韩国和我国台湾地区医保制度,重点阐述了这些国家和地区在防范重点人群医疗支出风险和医保费用监督管理方面的经验,如设置诊次固定缴费额度和(或)医保自负费用封顶线、加大重大疾病人群的医疗费用补助力度等,以期对我国医保制度改革提供借鉴。Since health care system reform in China, coverage and reimbursement have continuously in- creased. However, the effect of health insurance for vulnerable people and people who suffer from catastrophic disea- ses is still less than desirable. This article introduces the health insurance systems of Germany, Japan, Korea and Taiwan. In particular, it describes health insurance protection and the supervision and management of health insur- ance funds, including setting fixed fee per visit and/or a ceiling for out-of-pocket health expenditure, increasing the medical assistance provided to people who suffer from catastrophic diseases. This paper is intended to be a reference for ongoing health reform in China.

关 键 词：医保 个人现金卫生支出 封顶线 

分 类 号：R197[医药卫生—卫生事业管理]