美国百年医改的成败及其制度分析——新冠肺炎疫情下的美国医保之殇  

An Institutional Analysis on the US 100-Year Health Care Reform: The Failure of Its Medical System during the COVID-19 Outbreak

作　　者：张晓云 杜崇珊 李成威 Zhang Xiaoyun;Du Chongshan;Li Chengwei(Chinese Academy of Fiscal Sciences,Beijing)

机构地区：[1]中国财政科学研究院 [2]中国财政科学研究院全球风险治理研究中心

出　　处：《经济社会体制比较》2021年第4期149-160,共12页Comparative Economic & Social Systems

摘　　要：美国是医疗技术最发达的国家,也是发达经济体中唯一没有实现全民医保的国家。其医疗体系特别是医保制度的不完善在新冠肺炎疫情期间尤为凸显。文章梳理了美国的百年医改历程,并在国际比较基础上总结其医疗体系的特点,探究美国医改屡遭失败的原因。美国医疗体系失灵折射的是其文化和制度在构建社会安全网络上的失效。与之对比,我国应有文化和制度自信,在医改中要避免类似误区,注重整体规划设计,确保各部分协调运行,防止制度碎片化;还应构建起多层次医疗保障体系,兼顾公平和效率。这样的制度设计在确保最低收入阶层能获得基本医疗卫生保障的同时,又可以满足多样化需求,也有利于减轻财政压力。The United States has the most advanced medical technology worldwide. However, it is the only country in the developed world where full coverage of health insurance does not exist. The Covid-19 pandemic has completely unveiled imperfections in its healthcare system. This paper has studied the origins and development of US medical insurance, and analyzed the reasons why reforms have hardly been making great progress on promoting public insurance programs. Based on historical analysis and international comparison with other developed countries, this paper has summarized the flaws of US current healthcare. Also, the paper has analyzed the American cultural and institutional characteristics being partly the cause of its frustrated medical reform, and found that the US traditional culture and institutional arrangement has been preventing the country from building social safety nets that benefit all and especially the poor. Learning from foreign experience, with great cultural and institutional self-confidence, China should make further efforts to develop the medical system to improve fairness and efficiency. For the public healthcare, special attention must be paid to its overall planning to avoid system fragmentation. And a multi-pillar insurance is desirable in that it can provide the low-income group with basic medical service while satisfying diversified medical needs of high-income people. A well-designed system will be able to relieve fiscal pressure which may lead to fiscal risk.

关 键 词：美国医改 美国医保 制度分析 新冠肺炎疫情 

分 类 号：F813[经济管理—财政学] F817