中国基本医疗保险省级统筹的影响因素和经验模式研究  

The Models and Determinants of Upgrading China’s Social Basic Medical Insurance Scheme from the Prefecture Pooling Level to the Provincial Pooling Level

作　　者：付明卫[1] 徐文慧 FU Ming-wei;XU Wen-hui(Institute of Economics,Chinese Academy of Social Sciences,Beijing 100836,China;Graduate School,Chinese Academy of Social Sciences,Beijing 102488,China)

机构地区：[1]中国社会科学院经济研究所,北京100836 [2]中国社会科学院研究生院,北京102488

出　　处：《消费经济》2019年第5期6-13,共8页Consumer Economics

基　　金：国家社会科学基金一般项目(17BGL170)

摘　　要：统筹层次低是中国基本医疗保险制度体系存在的一大问题。尽管中国2011年明确提出了基本医疗保险实现省级统筹的目标,但目前仅有七个省区的城镇职工医疗保险实现了省级统筹。基于Probit模型的经验分析发现,一个省份的城镇职工医疗保险参保人数、区县经济发展水平差异和省财政直管县所占比例会影响省级统筹,但下辖区县数量对其没有影响。基于模型预测,在尚未实现省级统筹的省区中,仅有广西和吉林的省级统筹条件相对比较成熟。根据已实现省级统筹的省区的做法,为了顺利推进省级统筹,应将各分统筹区之前的统筹基金历年累计结余留给各分统筹区支配。实现省级统筹后,应让各分统筹区承担一定的财政担保责任,以降低各分统筹区监管上的道德风险行为。Pooling at a low level is one of primary problems faced by China’s social basic medical insurance schemes. Although China’s central government claimed clearly in 2011 that its social basic medical insurance schemes should pool at provincial level, merely seven provinces have realized this objective for their Urban Employee-based Medical Insurance Scheme(UEBMI) up to now. Employing a Probit model, our empirical study finds that the feasibility of upgrading the pooling level of UEBMI from the prefecture to the provincial relies on the total size of its enrollees, the income inequality among counties administered by the province, and the share of counties financially directly managed by the province, but not on the number of counties administered by the province. Based on the model prediction, among provinces having not achieved the objective, Guangxi and Jilin are suitable for upgrading their pooling level. According to the existent experience by the seven provinces, in order to facilitate the upgrading process, policy-decision maker should let the accumulated pooled-fund surplus of the prefectures before upgrading be managed by the prefectures after upgrading;moreover, after upgrading, to alleviate their moral hazard in supervision, prefectures should take certain responsibility by their public finance revenue for the upgraded pool.

关 键 词：省级统筹 医疗保险 调剂金模式 统收统支模式 

分 类 号：F842.684[经济管理—保险]