从“以收定支”到“以支定收”:论医疗保险筹资模式转变与可持续发展  

From"Setting the Expenditure Based on Income"to"Setting the Income Based on Expenditure":Study on the Transformation and Sustainable Development of Financing Model of Medical Insurance

作　　者：王昭茜 仇雨临[1] WANG Zhaoxi;QIU Yulin

机构地区：[1]中国人民大学劳动人事学院,北京100872

出　　处：《社会保障研究》2020年第4期3-9,共7页Social Security Studies

基　　金：研究阐释党的十九届四中全会精神国家社科基金重点项目“健全统筹城乡、可持续的基本医疗保险制度研究”(20AZD076)阶段性研究成果。

摘　　要：以科学合理的基金管理达到基金收支平衡是实现基本医疗保险制度可持续发展的前提。我国基本医疗保险制度建立之初确立了“以收定支、收支平衡”的基金管理原则,但实践中存在待遇保障差异、地区间医疗保险基金收支不平衡等弊端。从筹资模式的特征,基本医疗保险的制度目标、制度需求、制度环境及技术条件等方面分析医疗保险基金管理的逻辑,发现“以收定支”在制度建立之初有其合理性,但当前随着全民医保目标的升级,筹资模式需要做出适应性调整,即从“以收定支”转变为“以支定收”。对此,本文建议,通过建立基本医保筹资的动态调整机制、统一的待遇清单制度及多层次医疗保障体系,完善和创新医疗保险的管理手段,调整基金管理方式等路径,推动基本医疗保险的可持续发展。To achieve the balance of fund income and expenditure through scientific and reasonable fund management is the premise of realizing the sustainable development of basic medical insurance system.At the beginning of the establishment of the basic medical insurance system in China,the fund management principle of"setting the expenditure based income,balancing the revenue and expenditure"was established.However,in practice,there are some disadvantages,such as the difference of treatment guarantee,the imbalance of income and expenditure of medical insurance fund among regions.This study analyzes the logic of medical insurance fund management from the characteristics of financing model,system objectives,system demand,system environment and technical conditions of basic medical insurance,and finds that"setting the expenditure based on income"is reasonable at the beginning of system establishment.However,with the upgrading of the goal of universal health insurance,the financing model needs to be adjusted adaptively.That is changing from"setting expenditures based on income"to"setting income based on expenditures".Establishing a dynamic adjustment mechanism for the basic medical insurance financing,a unified treatment list system and a multi-level medical security system,improving and innovating the management means of medical insurance are suggested to adjust the fund management mode and promote the sustainable development of basic medical insurance.

关 键 词：基本医疗保险 筹资模式 以收定支 以支定收 

分 类 号：F83[经济管理—金融学]