摘要
我国的基本医疗保险制度一直以提高住院待遇水平,减少人民患大病的经济风险为出发点,基本医保实质上就是基本大病医保。然而在新时代下,这种以"保大病"为定位的医保制度已经无法满足人民日益增长的对健康生活的需求,同时在兼顾健康保障与费用控制方面面临越来越大的难题,医保制度改革与优化正面临着理念和定位的调整问题,即从只保大病走向大小病兼保。因此,本文在我国进行健康中国建设,构建预防为主的大健康格局背景下,研究"保小病"能否兼顾健康保障与费用控制,从而明确基本医保是否应该重视保障"小病"的问题,为医保的再定位提供决策依据。一方面论证了基本医疗保险"保小病"的学理依据和重要意义,另一方面构建起个人健康保障、个人医疗费用负担和医保基金收支平衡风险三个维度的制度评价框架。通过两部模型分析得出:医保对"小病"的保障水平与个人健康水平以及医保基金支出存在非线性关系,在[42. 27%,50.45%]的实际保障水平区间内,能够保障个人健康,降低个人患大病的风险;同时,既减少了个人医疗费用支出,又降低了医保基金支出过快的风险,从而起到控制社会医疗费用快速增长的作用,即"保小病"能够兼顾健康保障与费用控制。在考虑了参保人群、门诊待遇类别、医疗服务水平等方面异质性的情况下,本文的结论依旧稳健。
China's basic social health insurance system aims to improving the level of hospitalization treatment and reducing the financial risk of people suffering from serious diseases,therefore,the basic health insurance is essentially the basic health insurance for serious diseases.However,in the new era,such a system based on "insuring serious illness"has been unable to meet the people's growing demand for a healthy life,and at the same time it's facing a growing dilemma to balance the health protection and cost control.Therefore,the reform and optimization of the social health insurance System lies with conceptual change and repositioning,namely,moving from only covering serious illness towards covering both minor and serious illness.Under the background of the'Healthy China initiative and the formation of prevention-oriented inclusive health objective,it has both:theoretical value and practical significance to study whether the social health insurance system should cover "minor illness"and whether balance between health protection and cost control can be achieved when covering "minor illness".This can provide decision-making basis for the repositioning of the social health insurance.On the one hand,this paper analyzed and demonstrated the theoretical basis and important significance of "insuring minor diseases"in basic health insurance,and on the other hand,it innovatively constructed the system evaluation framework of three dimensions :personal health insurance,personal medical expense burden and the equilibrium risk of the basic insurance fund.Through the twopart model,it has been found that:there is a non-linear relationship between the level of insurance for "minor ailments"and personal health status as well as the expenditure of 'social health insurance fund.In the actual payment range of [42.27%,50.45%] ,it can protect personal health and reduce the risk of serious illness,and also reduce personal medical expenditure and quick draining of the fund',thus controls the rapid growth of social medical expenses.To su
作者
何文
申曙光
HE Wen;SHEN Shu-guang
出处
《保险研究》
CSSCI
北大核心
2018年第11期93-106,共14页
Insurance Studies
基金
国家社会科学基金重大项目"预防为主的大健康格局和健康中国建设研究"(17ZDA080)
教育部人文社会科学重点研究基地项目"社会政策创新与共享发展"(16JJD630011)的资助
关键词
基本医疗保险
保小病
健康保障
费用控制
basic social health insurance
insuring "minor illness"
health protection
cost control
