基本医保省级统筹后的政府间基金风险共担机制研究  

A Study on the Inter-governmental Fund Risk Sharing Mechanism for China’s Basic Medical Insurance at Provincial Level

作　　者：李亚青 Li Yaqing(School of Finance,Guangdong University of Finance and Economics,Guangzhou,510320)

机构地区：[1]广东财经大学金融学院

出　　处：《中国医疗保险》2020年第2期20-25,共6页China Health Insurance

基　　金：国家社科基金年度项目“医疗保障制度对健康平等的精准化改进研究”（18BJY215）

摘　　要：在实现制度全覆盖后,为提升基本医疗保险发展的平衡性和协调性,实行省级统筹已经成为关键一环。对此,需要解决的一个核心问题是如何建立省市两级政府间的基金风险共担机制。文章对省级统筹后的基金风险因素进行了分析,指出统筹层次提高后参保人、地方政府和医疗机构等各方的道德风险加大,以及可能造成"逆向再分配"风险,将成为威胁医保基金安全的新增因素;并基于重庆和宁夏两地的先行经验,以预算管理和工作目标考核制度为核心,提出了建立风险共担机制的初步方案。Upgrading the pooling system of China’s basic medical insurance to provincial level is key to achieve a balanced and harmonious development. In consider of this purpose, one of the core issues is to establish a risk sharing mechanism between the provincial-level and city-level administrations. The paper firstly analyzes the main possible risk factors of medical insurance at provincial level and concludes that the increasing moral hazard of the insured people, local government departments and the appointed medical institutions, as well as the risk of "reverse redistribution" could become the major newly emerged factors which will threat the safety of the pooling fund. Then the author introduces and summarizes the reform practices of Chongqing and Ningxia and suggests to construct the risk sharing mechanism with budget administration and performance appraisal system at the core.

关 键 词：医疗保险 省级统筹 基金风险 风险共担 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]