从机会公平到结果公平城乡居民基本医疗保险制度的演进逻辑  

From Equity of Opportunity to Equity of Outcome:The Evolutionary Logic of the Basic Medical Insurance System for Urban and Rural Residents

作　　者：储怡菲 吴方卫[2] CHU Yifei;WU Fangwei

机构地区：[1]上海财经大学财经研究所,上海200433 [2]上海财经大学城乡发展研究院,上海200433

出　　处：《农业经济问题》2025年第1期119-131,共13页Issues in Agricultural Economy

基　　金：国家自然科学基金面上项目“‘推—拉’力重构下中国农业转移劳动力空间再配置研究”(编号:72373089);国家社科基金一般项目“数字经济背景下农户电商采纳提升农业经营绩效的作用机制与实现路径研究”(编号:21BJY024)。

摘　　要：随着共同富裕远景目标的确立,城乡居民基本医疗保险制度的改革方向也从“全民医保”转向“公平医保”。鉴于城乡居民基本医疗保险促进社会公平的作用存在争议,有必要重新审视该制度调节医疗资源再分配的机制发挥。本文基于公平的定义和公平的内部关系,梳理中国城乡居民医保制度改革路径发现:从机会公平到结果公平,既是城乡居民医保制度改革的演进逻辑,也是医保再分配功能的实现路径,契合共同富裕的价值观选择。当前,以形式的机会公平为主导的城乡居民医保统筹降低了农村居民对医疗服务的相对获得,在城乡居民起点不公平的情况下,不但不能改善反而会加重城乡居民的医疗资源分配不均,使得医疗资源配置的公平性受到损害,威胁到城乡居民医保制度的可持续发展。因此,医保制度的下一步改革方向应当着力于缩小城乡居民的起点不公平,加大对农村居民的倾斜力度,助力“人人享有健康”。With the establishment of the vision of common prosperity,the direction of reform of the basic medical insurance system for urban and rural residents has shifted from"universal medical insur-ance"to"equitable medical insurance",In view of the controversy over the role of basic health insur-ance for urban and rural residents in promoting social equity,it is necessary to re-examine the role of this system in regulating the redistribution of healthcare resources.Based on the definition of fairness and the internal relationship of fairness,this article finds that the path of reforming China's urban and rural residents'health insurance system has evolved from fairness of opportunity to fairness of outcome,which is both the evolutionary logic of the urban and rural residents'health insurance reform and the path of realizing the redistributive function of the health insurance system,which is in line with the choice of common wealth.Currently,the urban-rural residents'health insurance coordination dominated by formal equity of opportunity reduces the relative access of rural residents to health care services,and in the case of inequitable starting points for urban and rural residents,it not only fails to improve but also exacerbates the unequal distribution of health care resources between urban and rural residents,which makes the fairness of health care resource allocation impaired,and threatens the sus-tainable development of urban-rural residents'health care insurance system.Therefore,the next step in the reform of the health insurance system should focus on narrowing the inequities between urban and rural residents at the outset and to increase the tilting of the system in favor of rural residents,so as to contribute to"health for all".

关 键 词：共同富裕 城乡居民基本医疗保险 机会公平 结果公平 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]