政府购买大病保险服务的政策演进路径研究  

Policy Evolution of Government Purchasing Critical Illness Insurance Service

作　　者：王琬[1] 闫晓旭[1] 

机构地区：[1]对外经济贸易大学保险经济学院,北京100029

出　　处：《江汉学术》2017年第6期5-11,共7页JIANGHAN ACADEMIC

基　　金：北京市社会科学基金项目"北京市城乡居民大病保险‘共保联办’模式研究"(15JGC182)

摘　　要：城乡居民大病保险是解决"因病致贫,因病返贫"问题的重要制度安排。从地方政府自发性探索到六部委局部试点,再到中央政府全面推广,大病保险政策也在不断调整和改进。政府购买大病保险服务是在地方政府多年实践探索上形成的经验总结,在医疗体制改革深入推进、政府公共管理全面转型的大背景下,这一政策的出台具有一定的历史必然性。大病保险的政策演进路径可划分为政府购买大病保险服务的自发探索、地方试点、推广三阶段,从公平、效率、质量三方面评估各阶段政府购买大病保险服务的政策效果。应将大病保险定位为补充保险,在政府部门严格监管下由保险公司独立运行,形成基本保险、补充保险、商业保险与慈善救助相衔接的多层次重特大疾病保障体系。这将对优化医疗保障体制机制、推动政府治理转型具有积极意义,同时有助于提高医疗保险服务的公平、效率和质量。Critical illness insurance program that covers both urban and rural citizens is an institutional ar- rangement to prevent people from ＂ falling into or returning to poverty because of illness＂. Starting from sponta- neous exploration by local governments, to piloting in a few regions by six ministries and commissions, to the central government＇ s promotion throughout the country, the critical illness insurance policy has experienced continuous adjustment and improvement. Government purchase of the insurance service is the result of local governments ＇ years of exploitation and practice and, therefore, under the background of furthering the medical reform and the overall transformation of public management, the introduction of this policy is historically inevi- table. The evolution of the policy has gone through three phases： spontaneous exploitation, piloting, and promo- tion; this paper attempts to evaluate the policy ＇ s effectiveness in each stage in the aspects of fairness, efficien- cy, and quality. The paper believes that the critical illness insurance should be defined as a supplementary as- surance operated by insurance companies through strict governmental monitoring. Together with basic and com- mercial insurances and charitable assistance, it forms a multilayered protective system for people who suffer from serious illnesses. This will positively optimize the medical protective system and mechanism and push for- ward the transformation of government administration; it will help enhance the fairness, efficiency, and quality of the medical insurance service.

关 键 词：大病保险 补充保险 政府购买服务 政策演进 医疗体制改革 

分 类 号：F842.6[经济管理—保险]