职工基本医疗保险个人账户的制度性缺陷及优化方向  

Institutional Deficiencies and Optimization Directions of Individual Accounts for Employee Basic Medical Insurance

作　　者：田梦佳 TIAN Mengjia

机构地区：[1]上海师范大学哲学与法政学院,上海200234

出　　处：《保险职业学院学报》2023年第6期5-9,共5页Journal of Insurance Professional College

摘　　要：职工基本医疗保险作为我国基本医疗保险体系的重要组成部分,为国家机关、企事业单位、社会团体等单位职工的基本医疗需求和健康保障提供了较为完备的制度支持,其资金筹集方式融合社会统筹和个人账户两种方式,即统账结合。社会统筹方式符合社会保障制度互助互济的建制原则,但个人账户的筹资方式难以顺应制度核心要求,个人账户基金盘活难度大且可利用率较低,其封闭性和非流动性将阻碍医疗保险制度的可持续发展。本文基于职工基本医疗保险制度个人账户设置的合理性,探讨个人账户的制度缺陷和现实运行障碍,分析个人账户改革的必要性,并提出相应的改革建议,以促进职工医保制度的可持续发展。As one of the three pillars of China’s basic medical insurance system,the basic medical in⁃surance for urban workers provides a more complete system support for the basic medical needs and health se⁃curity of employees in state organs,enterprises and institutions,social organizations and other units.Its fund raising method integrates the two ways of social overall planning and individual accounts,that is,the combi⁃nation of unified accounts.The way of social pooling conforms to the institutional principle of mutual assis⁃tance and mutual aid in the social security system,but the way of raising funds for individual accounts is con⁃trary to the core requirements of the system.It is difficult for individual account funds to be activated and the utilization rate is low,and its closed and illiquid nature will hinder the sustainable development of the medi⁃cal insurance system.Based on the reasonableness of the establishment of individual accounts in the urban em⁃ployee basic medical insurance system,this paper discusses the institutional defects and practical operation obstacles of individual accounts,analyzes the necessity of individual account reform,and puts forward corre⁃sponding reform suggestions to promote the sustainable development of the employee medical insurance system.

关 键 词：职工基本医疗保险 个人账户改革 统账结合 门诊共济 基金积累 

分 类 号：F840.613[经济管理—保险]