韩国国民健康保险的政策设计与价值取向探究  

A Study on Policy Design and Value Orientation of Korean National Health Insurance

作　　者：陈诚诚 袁嘉林 刘照彩 

机构地区：[1]北京信息科技大学公共管理与传媒学院,北京100192 [2]日照市社会保险事业中心,日照276827

出　　处：《中国医疗保险》2023年第7期120-128,共9页China Health Insurance

基　　金：国家社科基金一般项目“长期照护保险保障边界及制度衔接问题研究”(21BGL191)。

摘　　要：韩国国民健康保险自制度整合后,制度的公平性价值取向得到显著提升。在此之后,韩国国民健康保险改革无论是在缴费方法还是在待遇给付设计上始终坚持公平性的价值取向。在缴费方法上,由于居民收入差距较大、职工群体缴费负担整体偏低,改革致力于设计更加科学的缴费方法,使得职工和居民两类参保群体缴费负担更加公平。在待遇制度设计上,虽然制度改革目标是实现“国民医疗费用支出无负担”,但从制度整体表现来看,在四项重症疾病、灾难性医疗费用支出方面,韩国国民健康保险的保障水平处于OECD国家上游。在待遇给付方面,韩国国民健康保险对于居民群体,尤其是低收入居民群体的保障水平更高。基于此,本研究对韩国国民健康保险的制度设计、改革措施以及制度表现进行探究,分析其公平性问题,以期为推动实现我国基本医疗保障事业高质量发展的政策目标提供借鉴。Since the integration of the Korean health insurance system,the value orientation towards fairness has been significantly improved.After that,the value orientation of fairness runs through the reform of health insurance,both in the payment methods and design of benefits.In terms of payment methods,due to the large income gap between residents and the relatively low burden of employees,the government strives to design more scientific payment methods to make the payment level of employees and residents more balanced.In terms of the design of the benefit system,although the object the system reform is to realize"no burden on the national medical expenses",however,from the overall performance of the policy,the level of health insurance security of Korean health insurance system is at the upper end of OECD countries in terms of the four serious diseases and catastrophic medical expenses.As to the benefits,the level of health insurance security for residents,especially low-income residents,is higher.Based on this,this study explores the system design,reform measures and system performance of health insurance in South Korea,and analyzes its fairness to provide a reference for promoting the high-quality development of basic medical security in China.

关 键 词：韩国国民健康保险 公平性 待遇制度 缴费方法 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]