“十四五”时期医疗保障可持续性改革的三项任务  

Three Tasks in the Sustainable Reform of Medical Insurance SystemDuring the 14th Five-Year Plan Period

作　　者：郑秉文[1] ZHENG Bingwen

机构地区：[1]中国社会科学院大学政府管理学院,北京102488

出　　处：《社会保障研究》2021年第2期3-14,共12页Social Security Studies

摘　　要：“十四五”规划纲要提出的健全基本医保筹资和待遇调整机制、完善医疗保险参保缴费政策、实行医疗保障待遇清单制度,是医疗保障可持续性改革的三项任务。就筹资水平与结构来说,职工医保和居民医保都需要调整,均衡化的缴费比例结构有利于平衡筹资双方的权利与义务,以及为企业减负;就缴费政策和模式而言,实行职工医保终生缴费有利于提高医保制度的财务可持续性;而执行待遇清单制度能够框定医保与商保、政府与市场的责任边界。“十四五”开局之年将三项改革付诸实施对2035年乃至2050年实现医保制度可持续性和构建多层次医保制度体系具有战略意义。文章从执行待遇清单制度需注意的问题、医保缴费比例和公式的调整政策和策略、职工医保退休人员缴费政策的约束条件及法律修订等方面,对“十四五”期间三项改革任务的具体实现路径提出政策建议。The 14th Five-Year Plan puts forward three tasks in the sustainable reform of medical insurance system,including improving the financing and treatment adjustment mechanism of basic medical insurance,improving the contributions policy of medical insurance,and implementing the treatment list system of medical insurance.In terms of the financing level and structure,both the medical insurance for employees and the medical insurance for residents need adjusting.The balanced proportion structure of contributions is conducive to balancing the rights and obligations of both financing parties and reducing the burden of enterprises.As for the contributions policy and mode,the implementation of lifetime payment of medical insurance for employees is beneficial to improve the financial sustainability of the medical insurance system.The implementation of the treatment list system can frame the responsibility boundary between medical insurance and commercial insurance,government and market.To put the three reforms into practice in the beginning year of the 14th Five-Year Plan is of strategic significance for realizing the sustainability of the medical insurance system and building a multi-level medical insurance system by 2035 and even 2050.This paper puts forward some policy suggestions on the specific path of the three reform tasks during the 14th Five-Year Plan period from the aspects of the problems that should be paid attention to in the implementation of the treatment list system,the adjustment policies and strategies of the proportion and formula of medical insurance contributions,constraint conditions of the contributory policy for retirees who participate in medical insurance for employees and the revision of the law.

关 键 词：医疗保险筹资 医疗保险缴费 医疗保障改革 商业健康保险 “十四五”规划 

分 类 号：F27[经济管理—企业管理]