我国医疗保障制度面临的道德风险与防范对策——从儒家医疗正义观的视角出发

An Examination of the Moral Hazards that China's Health Care System is Facing from Confucian Concept of Justice

我国医疗保障制度建基于个人主义平等主义的医疗正义观,最终要实现由政府主要出资的全民医保的保障目标。这决定了这一医疗保障制度的道德风险将来自被保险者对免费或折价医疗的依赖,由此可能带来医疗保障制度在经济上的不可持续性。然而从儒家医疗正义观的视角来看,疾病与残疾并不是一种社会不公平,而是一种个人不幸,因此医疗保障的责任应该从政府转移给家庭。所以,从儒家医疗正义观的考量出发,建立一种家庭医疗储蓄账户制度以取代当前的个人账户制度,可能是避免道德风险的更好选择。

The Chinese Healthcare Savings Accounts(HSAs)are based on medical justice with individualistic equalitarianism.The government aims to achieve the goal of government-funded health care.This may cause the moral hazards in which the insured will depend on free or discount medical care and consequently financial unsustainability of healthcare may arise.However,According to Confucian ethics,illness and disability is not a social injustice but a misfortune for individuals,therefore the responsibility of healthcare should be shifted from the government to the family.According to Confucianism,it may be a better choice to build familial HSAs instead of individualistic HSAs so as to discourage the moral hazards.