医疗保险个人账户机制创新及其可行性研究——基于患者道德风险的分析

Medical Insurance Innovation of Mechanism and Feasibility Research of Personal Account——Analysis on the Basis of Patient's Morals Risk

我国目前实行“统账结合”的医疗保险模式,其医疗个人账户的设计与统筹账户中设定的起付线、封顶线以及患者自付比例等限制性参数都是为了控制医患双方的“道德风险”及其“串谋”的频率。但本文对患者道德风险产生过程与机理的实地调研表明:在“统账结合”的医疗保险模式下,患者的各种道德风险均是以其个人账户为基础的;我国现行的医疗保险个人账户缴费机制也因此存在进一步改进和创新的空间。本文将根据先验保费原理以及个人账户实行社会医疗保险卡(IC卡)制度,设计出一种新的个人账户缴费机制。这种机制创新无论对于被保险人道德风险的规避,还是缓解个人账户纵向积累的矛盾都将起到重要作用。

Our country implements the medical insurance mode that ＂The pool combines with personal account＂ at present o The getting up in one pair of lines of design and conducting establishing in accounts of the medical personal account, bind line and patient pay for itself proportion, etc. restricted parameter for control doctors and patients of both sides ＂morals risk＂ and frequency on＂ bunch work for ＂o Whether but this text produce to patient morals risk course and mechanism is it indicates to survey and study on the spot. Under the medical insurance mode that＂ the interconnected system account accords with＂, various kinds of morals risks of the patient＇s are based on its personal accounto Our country current medical insurance personal account pay the fees mechanism too for improve and space that innovate further. This paper will implement the system of the social medical insurance card （ IC card ） according to the premium principle of priori and personal account, mechanism that design a kind of new personal account and pay the fees. No matter evading to the assured＇s morals risk of this kind of innovation of mechanism, alleviating the vertical contradictions that accumulates of the personal accounts will all play a important role.