基本医疗保险省级统筹的科学内涵与路径优化  

Scientific Connotation and Path Optimization of Provincial Overall Planning of Basic Medical Insurance

作　　者：袁涛 Yuan Tao

机构地区：[1]中国人口与发展研究中心健康中国研究中心,北京100081

出　　处：《中州学刊》2022年第12期85-94,共10页Academic Journal of Zhongzhou

基　　金：贵州省哲学社会科学规划课题“健康中国视域下基本医疗保险筹资优化机制研究”(19GZYB66);河北省医疗保障局立项课题“完善基本医疗保险筹资机制研究”(JYB210102);广西壮族自治区医疗保障局立项课题“基本医疗保险省级统筹路径研究”(GX202202)。

摘　　要：基本医疗保险省级统筹目标的确立由来已久,但实际进展低于预期,主要原因是各界对其科学内涵和实施路径存在认识分歧。应充分认识基本医疗保险省级统筹对提高医保基金共济能力的有限性,厘清其科学内涵。基本医疗保险省级统筹的首要价值目标是增强医保制度的公平性和统一性,提升医保治理能力,而不是提高基金共济能力。基本医疗保险省级统筹不等于“统收统支”,其“调剂金制度”也必须以统一制度为前提。推进基本医疗保险省级统筹需要优化实施路径,按照“省统市管、分级管理、统一政策、统一调剂”的原则,在先行统一医保筹资和待遇支付政策规定的基础上,科学推进基本医疗保险省级统筹,推动全民医保高质量发展。The provincial overall planning goal of basic medical insurance has been established for a long time,but the actual progress is still lower than expected.The main reason is that people from all walks of life have different understanding of its scientific connotation and implementation path.We should fully understand the limitation of provincial pooling of basic medical insurance to improve the mutual aid ability of medical insurance funds,and clarify its scientific connotation.The primary value objective of provincial overall planning of basic medical insurance is to enhance the fairness and unity of the medical insurance system and improve the medical insurance governance ability,rather than improve the mutual aid ability of the fund.The provincial pooling of basic medical insurance is not equal to“unified income and expenditure”.And its“system of adjustment fund”must also be based on a unified system.To promote the provincial overall planning of basic medical insurance,we need to carry out model innovation.In accordance with the principle of“unified provincial and municipal management,hierarchical management,unified policy and unified adjustment”,and on the basis of first unifying the policy provisions on medical insurance financing and treatment payment,we should scientifically promote the provincial overall planning of basic medical insurance,and promote the high-quality development of medical insurance for all.

关 键 词：医疗保险 省级统筹 调剂金 路径优化 

分 类 号：C913.7[经济管理]