城镇医疗保险制度改革:政府与市场的作用

Urban Health Insurance System Reform in China: Role of the Government and the Market

我国现行医疗保险制度的覆盖率、医疗服务的成本 (效率、成本控制 )、质量与公平性等指标都亟待进一步改进。由于医疗保险与服务的特殊性 ,需要通过适当的政府干预来纠正“市场失灵” ,并确保医疗服务利用的社会公平性。但是政府干预也会产生“政府失灵”并造成社会福利损失。有鉴于此 ,作者在审视医疗保险的有关理论与世界各国实践的基础上 ,就我国的城镇医疗保险制度改革如何更好地发挥政府与市场的作用提出了相关建议。作者认为 ,我国城镇医疗保险制度改革的关键 ,是通过进一步引入市场机制来提高医疗服务资源的利用效率 ,同时强化政府保护消费者利益和向弱势人群提供最后保险的职能。

The coverage of the current Chinese urban health care system, its cost (efficiency and cost control), quality and accessibility all call for urgent improvement. In view of the specific characteristics of health insurance and health care services, government intervention is needed to correct “market failure' and to ensure equity in access to health service. However, government intervention might cause “government failure,' which will, in turn, result in social welfare losses. Based on a broad overview of health insurance theories and practices in different countries of the world and taking into account the reality in China, the authors make several suggestions on the better functioning of the government and the market in the reform of urban health insurance. They argue that the key to the success of the reform of urban health insurance system is to enhance the efficiency of health care resources allocation through the market mechanism and, in the meantime, strengthen the government's role in protecting the consumer interests and in providing the vulnerable groups with ultimate insurance.