变“悬崖效应”为“缓坡效应”?——2020年后医疗保障扶贫政策的调整探讨

Transferring “Cliff Effect” into “Gentle Slope Effect”? The Adjustment of Medical Insurance Policies for Poverty Alleviation After 2020

脱贫攻坚期贫困人口和非贫困人口在享受医疗保障政策方面存在的巨大不平衡,是2020年后巩固拓展脱贫攻坚成果同乡村振兴有效衔接需要认真考虑的问题。本文基于江西省和河南省6个摘帽贫困县的实地调研数据,对改进贫困人口医疗保障政策的可行性进行了分析,发现脱贫攻坚期内,贫困人口享受的医疗保障福利明显高于非贫困人口,医疗保障政策在贫困人口和非贫困人口之间造成的福利"悬崖效应"明显;脱贫攻坚期结束后,将现行的贫困人口医疗保障政策简单"复制"推广到非贫困人口,会给地方财政带来较大的压力,不具有可行性。2020年后,可以考虑在分类识别保障对象的前提下,实施调整保费补贴政策、调整医疗报销政策和调整医疗保障基金账户结构三项措施,对脱贫攻坚期超常规的医疗保障扶贫政策进行调整。改进后的医疗保障政策能够在不显著增加地方政府财政负担的情况下,合理缩小不同群体间的医疗保障福利差距,变医疗保障福利的"悬崖效应"为"缓坡效应",将脱贫攻坚期的医疗保障扶贫政策逐步过渡融入乡村振兴战略。

The disequilibrium on medical insurance policies between the impoverished and non-impoverished groups during the poverty alleviation period has become a problem of concern under the background of consolidating the achievements of poverty alleviation and effectively linking with rural revitalization in the next stage.Based on the first-hand data of six counties being lifted out of poverty in Jiangxi and Henan,this article analyzes the feasibility of improving the medical insurance policies for rural residents.It finds that currently the medical insurance benefits enjoyed by the impoverished people are significantly higher than those by the non-impoverished,which demonstrates a clear"cliff effect"in rural medical insurance policies.However,it is not feasible to simply"copy"and generalize the policies aimed to the impoverished to the non-impoverished group in the future,as such may cause large pressure to local fiscal systems.In order to better integrate poverty alleviation policies into rural revitalization strategy,China may consider implementing the following measures:recognizing distinct insured groups as a premise,and taking measures to adjust the insurance premium,the framework of medical insurance systems,and the structure of the medical insurance fund to improve the current medical insurance system.The newly improved medical insurance system can help transfer the"cliff effect"to"gentle slope effect",which can help reduce the relative poverty and integrate poverty reduction policy into the strategy of ruralrevitalization.