全面深化医保改革:进展、挑战与纵深推进  

Comprehensively Deepening Health Care Reforms:Progress,Challenges and Advancement

作　　者：郑功成 Zheng Gongcheng

机构地区：[1]中国社会保障学会 [2]中国人民大学中国社会保障研究中心

出　　处：《行政管理改革》2021年第10期12-25,共14页Administration Reform

基　　金：国家社会科学基金重大项目“中国社会保障体系建设与扎实推进共同富裕研究”(21STA002)。

摘　　要：我国已进入全面深化医保改革新阶段,国家通过出台顶层设计、制定医保基金使用监管法规、改革职工医保个人账户、推进市级统筹、实行药品与耗材集中带量采购、扩大按疾病诊断相关分组付费和按病种分值付费试点、建立待遇清单制、发展“惠民保”等一系列重大改革措施,使医保制度释放出日益巨大的改革红利。但也面临着社会风险加剧、财务风险加大、人民群众诉求发生变化以及“三医”之间要求良性互动的挑战。要推进医保改革向纵深发展,需要进一步明确“十四五”“十五五”时期的阶段性目标任务,加快优化现行基本医疗保险制度并力促商业健康保险得到发展,同时还须加快推进医保经办服务机制改革步伐,推进医疗保障法治化进程,尽早建成全国统一的医保信息平台。China has entered a new stage of comprehensively deepening the reform of its health care system.Major reform measures,including the formulation of the overarching design of the healthcare system,introduction of regulations on the use of medical insurance funds,reform of individual accounts in employees’medical insurance scheme,city-based social pooling of insurance fund,centralized procurement of drugs and medical consumables,Diagnosis-Related Group and Diagnosis-Intervention Packet payment pilots,establishment of a benefit list system,and the development of supplementary commercial health insurance,have enabled the health care system to release its ever-growing reform dividends.However,there are also challenges such as increased social risks and financial risks,changes in the demands of the people,as well as a not yet benign interaction between the healthcare payers and providers.To promote further health care reform,it is necessary to further first clarify the phased goals and tasks of the"14th Five-Year Plan"and the"15th Five-Year Plan"period,second is to improve the basic medical insurance system and meanwhile promote the development of commercial health insurance,third is toexpedite reforms on the management mechanism for medical insurance;moreover,it requires to expedite legal construction on healthcare and establish a nationally unified information platform for medical insurance.

关 键 词：医疗保障制度 医疗保障改革 改革红利 纵深推进 

分 类 号：D63[政治法律—政治学]