未来5~10年中国医疗保障待遇设计的改革思路  

Reform Ideas for the Design of Medical Security Benefits in China in the next 5-10 Years

作　　者：于保荣[1] 张琼 郑艺慧 YU Baorong;ZHANG Qiong;ZHENG Yihui(School of Insurance and Economics,University of International Business and Economics,Beijing 100029,China;不详)

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2期19-22,共4页

基　　金：国家医疗保障局委托2021—2022年度“基本医保待遇保障具体项目设置研究”(A21072)。

摘　　要：医疗保障待遇包括起付线、报销比例、封顶线等内容。典型国家社会医疗保险报销起付线多设置在人均年收入的3%以内,对门诊、住院和药剂服务设立了不同的支付政策,医疗费用个人自付占可支配收入的比例在0.25%~2%。借鉴国际经验,展望中国社会医疗保险制度未来的发展,建议提高门诊保障待遇,以可支配收入为基数设置报销起付线,不同层级医疗机构实行相同的报销比例,设置个人自付封顶线,取消门诊报销封顶线,门诊和住院共用个人最高自付限额。The design of benefit of health insurance scheme includes deductible,co-payment ratio and the ceiling.For typical health scheme the deductible usually is set within 3%of the national per capita annual income.Different payment policies are often established for outpatient,inpatient and pharmaceutical services.Individual out-of-pocket payments for annual medical expenses range 0.25%-2%of disposable income.Drawing on international experience and looking forward to the future development of China's social medical insurance system,the authors suggest to Improve outpatient security benefits,set up the deductible basing on disposable income,break the hierarchical reimbursement system,establish an out-of-pocket expenses ceiling,cancel the outpatients'reimbursement ceiling and merge it with the maximum out-of-pocket payment of inpatients.

关 键 词：医疗保障制度 保障待遇 起付线 报销比例 封顶线 

分 类 号：R197[医药卫生—卫生事业管理]