城乡居民基本医疗保险分档筹资的实施效果分析  

Analysis of the Implementation Effect of Graded Financing of Basic Medical Insurance for Urban and Rural Residents

作　　者：陈罗炜 CHEN Luowei

机构地区：[1]中南财经政法大学财政税务学院,湖北武汉430073

出　　处：《保险职业学院学报》2024年第5期11-17,共7页Journal of Insurance Professional College

摘　　要：本文通过明确分档筹资模式,梳理各地分档筹资政策,分析了分档筹资对居民医保参保负担及基金可持续性的影响。研究发现:按待遇分档未减轻参保负担,按年龄分档一定程度减轻了参保负担,分档筹资对促进医保基金收支平衡的效果有限,对分档筹资模式认知不清、分档筹资与中央政策衔接不畅、分档筹资功能定位模糊错位是影响分档筹资实施效果的主要原因,据此提出明确分档筹资概念及作用、做好分档筹资与其他政策措施配套衔接、因地制宜发挥不同分档筹资模式作用的政策建议。This paper analyzes the effects of graded financing on the burden of participation and fund sustainability of residents’health insurance by clarifying the graded financing model and sorting out the graded financing policies in different regions.The study finds that the tiering by treatment does not reduce the burden of participation,the tiering by age reduces the burden of participation to a certain extent,and the effect of tiering on promoting the balance of income and expenditure of the health insurance fund is limited.The main reasons for the impact on the effectiveness of the implementation of the graded financing model are unclear understanding of the model,poor articulation between the graded financing and the centralized policy,and ambiguous and misplaced positioning of the functions of the graded financing.Accordingly,policy recommendations are put forward for clarifying the conceptual role of the graded financing,making good progress in the articulation between the graded financing and other policy measures,and giving full play to the functions of the different graded financing models in accordance with the local conditions.

关 键 词：居民医保 分档筹资 参保负担 基金收支平衡 医保可持续性 

分 类 号：F840.613[经济管理—保险]