职工医保个人账户制度:发展历程与优化路径  

Personal Account System of Employees’Medical Insurance:Development Process and Optimization Path

作　　者：徐晓雯 李泽臻 XU Xiaowen;LI Zezhen(School of Finance and Taxation,Shandong University of Finance and Economics,Jinan 250014,China;School of Public Administration,Shandong University of Finance and Economics,Jinan 250014,China)

机构地区：[1]山东财经大学财政税务学院,山东济南250014 [2]山东财经大学公共管理学院,山东济南250014

出　　处：《福建商学院学报》2021年第1期7-14,共8页Journal of Fujian Business University

基　　金：山东省社科规划重点项目“山东省促进绿色经济发展的财税政策研究”(18BJJJ07)。

摘　　要：城镇职工基本医疗保险个人账户制度是我国医疗保障制度的核心内容之一,发挥着保障职工医疗安全的作用。理论研究表明,福利经济学和制度变迁理论分别是职工医保个人账户制度建立的理论依据和改革保障。个人账户制度经过探索期、创建期和改革期的发展历程,得以逐步完善,但随着参保人数的持续增加,个人账户的弊端也日益显现。在新形势下,完善职工基本医保个人账户制度的路径主要有:扩大个人账户支付,回归互助共济功能;完善职工基本医疗保险门诊统筹政策;创新管理机制,强化医疗服务监管;采取激励机制引导参保者正确使用个人账户;重视意识形态在改革中的特殊作用。The individual account system of basic medical insurance for urban employees is one of the core contents of China’s medical security system,which plays a role in ensuring the medical safety of employees.The theoretical research shows that welfare economics and institutional change theory are the theoretical basis and reform guarantee of the establishment of employees’medical insurance personal account system.The personal account system has been gradually improved through the exploration period,the establishment period and the reform period.However,with the continuous increase in the number of insured,the disadvantages of personal account are also increasingly apparent.Under the new situation,the main ways to improve the personal account system of employees’basic medical insurance include:expanding individual account payment,returning to the function of mutual assistance and mutual aid;improving the outpatient co-ordination policy of employees’basic medical insurance;innovating management mechanism and strengthening medical service supervision;adopting incentive mechanism to guide the insured to use personal account correctly and paying attention to the special role of ideology in the reform.

关 键 词：基本医疗保险个人账户 医疗保障制度改革 制度变迁 帕累托改进 

分 类 号：F840.613[经济管理—保险]