构建医保筹资与待遇支付关联机制的理论思考  

Theoretical Thinking on the Mechanism for Correlating Fundraising of Medical Insurance and Benefit Payments

作　　者：袁涛 Yuan Tao(Finance and Economics University of Gnizhou,Guiyang 550000,China)

机构地区：[1]中国劳动与社会保障科学研究院 [2]贵州财经大学公共管理学院

出　　处：《社会保障评论》2018年第4期149-159,共11页Chinese Social Security Review

基　　金：贵州省理论创新课题"医保筹资与待遇调整关联机制研究"(GZLLLH2017017)

摘　　要：筹资和待遇支付是医保制度的核心。稳定的筹资机制及对应的待遇保障机制是医保制度可持续发展的基石。我国职工医保长期坚持"以收定支"财务平衡原则,反思其实践效果,存在着不利于有效控制制度的福利成本,不利于为参保群众提供稳定的待遇预期,欠缺对未来风险的积极响应等固有缺陷,且难以适应今后基金征缴与待遇支付分开管理的现实改革需要。为解决上述问题,本文从构建医保筹资与待遇支付关联机制的整体视角,提出新时期积极应对我国医保管理体制改革,在筹资方面坚持"以支定收"原则编制筹资预算,在待遇支付方面坚持"以收定支"原则编制支出预算的新型医保基金管理策略。Financing and paying benefi ts are the cores of medical insurance systems. A reliable mechanism for fi nancing and paying benefi ts is the cornerstone for sustainable development of medical insurance systems. China’s medical insurance scheme for urban employees has been following the principle of "fund-revenue determined expenditure", causing persistent problems, including diffi culties in controlling costs and providing stable expectations for the insured, as well as responding actively to future risks. Moreover, this model makes it diffi cult to adapt to future reform that separates revenue collection from payout of the fund. To address these problems, this paper takes a holistic perspective that correlates fund-raising with benefi t payment, and discusses reform proposals for the administrative structure of the medical insurance system in China. A new strategy is proposed to manage the medical insurance fund, which follows the principle of "expenditure determined revenue" and "revenue determined expenditure" in regards to fundraising and paying benefi ts, respectively.

关 键 词：医疗保险 筹资 待遇调整 关联机制 

分 类 号：F842.684[经济管理—保险]