居民基本医疗保险:筹资政策、实践效应及其优化  

The Resident Basic Medical Insurance:Financing Policies, Implementation Effects and Optimization

作　　者：华颖[1] HUA Ying(The Institute of Population and Labor Economics,Chinese Academy of Social Sciences,Beijing 100732)

机构地区：[1]中国社会科学院人口与劳动经济研究所,北京100732

出　　处：《长白学刊》2023年第2期128-138,共11页Changbai Journal

基　　金：中国社会科学院习近平新时代中国特色社会主义思想研究中心2022年度重点项目“健康保障与健康中国建设研究”(2022XYZD06)。

摘　　要：居民基本医疗保险覆盖我国约3/4的人口,对减轻城乡居民疾病后顾之忧发挥着愈加重要的作用,参保者的获得感、安全感明显增强,这一成就在很大程度依靠的是政府承担着主要筹资责任以及制度的高效运行。然而,现行筹资机制存在的个人筹资方式有违按照能力确定缴费的基本原则、政府与个人责任失衡、人户分离与政府补贴责任难以匹配、筹资水平偏低等问题正在影响着这一重要制度的健康发展。未来方向应当是由个人等额缴费制转向收入关联型缴费制,建立“以支定收”原则下的筹资标准动态调整机制,将按人头划拨大病保险制度的资金回归基本医保,同时依据覆盖常住人口原则调整政府责任,并促使政府与个人筹资责任逐步走向均衡。The resident basic medical insurance covers about three quarters of China’s population, and plays an increasingly important role in alleviating the worries of urban and rural residents about diseases. The sense of gain and security of the insured has been significantly enhanced. This achievement depends to a large extent on the government assuming the main responsibility for financing and the efficient operation of the system. However, the problems existing in the current financing mechanism, such as the failure to follow through with the principle of determining individual contributions according to the ability to pay, the imbalance in sharing of financial burdens between governments and individuals, the mismatched government subsidies resulting from population movements and the inadequacy of revenue. The future direction should be to shift from a flat rate to income-related individual contribution, establishing a dynamic mechanism for“adjusting revenue to be collected according to the defined expenditure”, return the funds allocated by head to the major disease insurance system to the basic medical insurance, at the same time, adjust the government responsibility according to the principle of covering the permanent population, and promote the government and individual financing responsibility to gradually balance.

关 键 词：居民基本医疗保险 筹资机制 筹资公平 可持续性 充足性 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]