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    普惠型补充医疗保险制度改革案例

    摘要

    以绍兴市、衢州市和珠海市为例,本报告剖析了普惠型补充医疗保险制度改革典型案例,包括筹资及参保、赔付支出、运营费用和成效等。可以发现,上述普惠型补充医疗保险项目对于老人和既往症患者不设参保门槛,统一保费金额、保障范围和待遇标准,以市场化机制实现社会公益性目标,与基本医疗保险实现无缝衔接,构建起“防止因病致贫”新防线,有效化解了大病重症患者的高额医药费用负担。项目没有增加政府财政支出,整体运行稳健,积极探索向“以健康为中心”转变,实现了可持续发展,在完善多层次医疗保障体系方面迈出了重要一步。

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    Abstract

    Taking Shaoxing,Quzhou and Zhuhai as examples,this report analyzes the typical cases of the reform of the inclusive supplementary medical insurance,including financing and insurance,reimbursement expenses,operating expenses and effectiveness. The results showed that the inclusive supplementary medical insurance program did not set the insurance threshold for the elderly and patients with previous diseases,unified the premium amount,coverage and treatment standard,and solved the social welfare objectives with the market-oriented mechanism,so as to achieve seamless connection with the basic medical insurance. This has established a new guarantee to prevent poverty caused by illness,and effectively alleviated the burden of high medical expenses for patients with serious diseases and severe diseases. The project did not increase government financial expenditure,and the overall operation was stable. It actively explores the transformation to “health-centered”,realizes sustainable development,and makes an important step in improving the multi-level medical security system.

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    作者简介
    阎建军:阎建军,中国社会科学院金融研究所创新工程执行研究员,国家金融与发展实验室保险与发展研究中心主任。
    施毓凤:施毓凤,上海健康医学院护理与健康管理学院副教授。
    施敏盈:施敏盈,中国人寿保险股份有限公司上海市分公司健康保险事业部原总经理。
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