中国社会医疗保险制度未来发展的挑战与创新建议  

Challenges and Innovation Recommendations for Social Health Insurance Scheme Development in China

作　　者：于保荣[1] YU Baorong(School of Insurance and Economics,University of International Business and Economics,Beijing 100029,China)

机构地区：[1]对外经济贸易大学保险学院,北京100029

出　　处：《卫生经济研究》2024年第1期20-22,28,共4页

基　　金：国家医疗保障局委托课题“基本医保待遇保障具体项目设置”(306/A21072),“中国社会医疗保障筹资、待遇水平和制度优化研究”(306/H19125)。

摘　　要：中国社会医疗保险制度发展至今,已覆盖了95%以上的人口,筹资和报销待遇都达到了与国民经济所处的中等收入国家地位相称的水平,但也存在不同人群待遇相差悬殊、医保基金使用效率不高的问题。未来需要从实现公平的国民待遇、进行科学的医保筹资规划、制定统一的医疗服务价格、设计合理的医保报销政策、明确划分中央与地方政府的职责等方面,正视挑战,创新发展,避免医保制度发展的中等收入陷阱。Since the development of social health insurance scheme(SHIS),it has covered over 95%of the population in China,and the current level of financing and reimbursement benefits has reached a level commensurate with that of middle-income countries.However,there are also problems such as wide difference in benefit among different groups,low efficiency of the utilization of SHIS funds.For its future development,it is necessary to focus on the realization of fair benefit for all,plan medical insurance financing scientifically,formulate unified medical service prices,design reasonable medical service insurance reimbursement policy,divide responsibilities between the central government and local governments clearly,to avoid the middle-income trap in SHIS development.

关 键 词：社会医疗保险制度 医保筹资规划 医保报销政策 医疗服务价格 中等收入陷阱 

分 类 号：F840.684[经济管理—保险]