“1+3+N”多层次医疗保障体系协同发展研究——基于待遇给付视角  

Research on the Coordinated Development of "1+3+N" Multi-Level Healthcare Security System——Based on the Perspective of Treatment Payment

作　　者：胡宏伟 刘堂森 

机构地区：[1]中国人民大学公共管理学院,北京100872 [2]中国人民大学健康保障研究中心,北京100872

出　　处：《中国医疗保险》2025年第4期5-12,共8页China Health Insurance

基　　金：北京市社会科学基金项目重点项目“失能失智老人家庭照护社会支持体系优化研究”(24SRA006)。

摘　　要：“1+3+N”多层次医疗保障体系协同发展是提升医疗保障待遇水平的重要途径。在厘清多层次医疗保障体系待遇给付次序的形成路径后发现,给付次序的优化根本上依赖于基本医保“三重保障”和“其他保障力量”各层次错位协同发展,实现“目标协同、功能错位、内容互补”的目标。具体而言,“三重保障”要以制度整合为方向,持续推进医保筹资机制和支付方式改革,在“充分的保基本”目标基础上进一步促进健康公平;传统商业健康险要坚持以“多元医疗需求满足”为核心的错位发展,致力于群众差异化医疗需求保障;惠民保和职工互助保障要坚持以“基本医疗费用补偿”为核心的错位发展,弥补基本制度重特大疾病保障不足的缺口。The coordinated development of the "1+3+N" multi-level healthcare security system is an important measure to improve the level of healthcare security treatment.The optimization of the payment order fundamentally depends on the misplacement and coordinated development of the "triple security" and "other security forces" levels by analyzing the formation path of the treatment payment order of various levels.We must adhere to the principles of “goal synergy,functional misplacement,and content complementation” between "3" and "N".Specifically,the "triple security" should be guided by system integration,continue to promote the reform of medical insurance financing mechanism and payment methods,and further promote health equity on the basis of the goal of “adequate security of basic medical needs”.Traditional commercial health insurance should adhere to the misplacement development with “diversified medical needs satisfaction” as the core,and strive to meet the differentiated medical needs of the public.City-customized commercial health insurance and mutual aid insurance for employees should adhere to the misplacement development with “basic medical expense compensation” as the core to make up for the gap in the basic system for major diseases.

关 键 词：1+3+N 多层次医疗保障 待遇给付 错位协同 

分 类 号：F840.684[经济管理—保险]