缴费即参保可行性及实施路径研究  

Research on the Feasibility and Implementation Path of Payment as Insurance Participation

作　　者：谭中和 

机构地区：[1]中国劳动学会,北京100013 [2]中国社会科学院大学公共政策研究中心,北京100102

出　　处：《中国医疗保险》2023年第11期5-21,共17页China Health Insurance

摘　　要：参保和缴费是医疗保险工作的首要环节,是新时期实现医疗保障高质量发展的基础。应保尽保、应缴尽缴是医保经办的重要职责。“参保”包含了基本信息登记、信息的变更,只有依法足额缴纳了医保费,才能确立医疗保险关系。本研究通过调查分析我国目前的参保缴费模式、具体实施过程以及各地代表性做法,认为其已不适应新时期发展要求,表现在部门之间参保缴费职责不清,缺乏全国统一的标准和规范,征缴机构和医保经办机构间相关信息不能及时共享,参保者欠费、少缴、中断参保和缴费、重复参保和缴费以及对缴费中的历史遗留问题缺乏合理有效的处理机制等。建议改革先行参保登记、审核资料、核定缴费、缴费的流程,归并为“缴费即参保”“一件事一次办”;全面实行法人和个人自主申报缴费和根据个人信息变更情况自主修改参保信息;建立以方便参保单位和居民为中心的参保缴费机制,健全完善医保和税务部门稽核核查机制,确保参保主体申报信息准确、缴纳费用真实,实现应保尽保和应缴尽缴目标。Insurance participation and payment is the first step in medical insurance,and the foundation of high-quality development of healthcare security in the new era.Ensuring full coverage and paying full contributions are important responsibilities of medical insurance agencies.Participating in insurance includes the registration of basic information and changes in information.Only by paying the fees in full in accordance with the law can a medical insurance relationship be established.This study investigates and analyzes the current insurance payment models,specific implementation process,and representative practice in various regions in China.It is believed that they are no longer suitable for the development requirements of the new era,manifested in unclear responsibilities for insurance payment among departments,lack of unified national standards and norms,and inability to timely share relevant information between payment agencies and medical insurance agencies.Participants are in arrears,underpayment,interruption of insurance participation and payment,repeated participation in insurance and payment,as well as the lack of a reasonable and effective mechanism for historical legacy issues in payment.It is suggested reforming the process of registration,reviewing materials,verifying payment and paying fees,and merging them into"payment means participating in insurance"and"handling each matter once",Independent declaration and payment by legal persons and individuals,and independently modify insurance information based on personal information changes should be fully implemented.Meanwhile,we should establish an insurance payment mechanism for the convenience of insured units and residents,improve the audit and verification mechanism of medical insurance and tax departments,ensure accurate declaration information and truthful payment fees of insured subjects,and achieve the goals of full coverage and paying full contributions.

关 键 词：参保缴费 缴费即参保 医保高质量发展 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]