福利多元主义视角下的医疗保险政策分析

Analyzing Health Insurance Reform in China:A Welfare Pluralist Perspective

论文以近年来在西方社会福利与社会政策领域广为盛行的福利多元主义为分析视角,结合调查数据,对我国城市医疗保险改革实践问题进行了实证考察。以福利多元范式分析我国医疗保险改革将发现,不同医疗保障形式因政府、市场和社会三方主体的不同组合而在保障水平上呈现出很大差异,这种差异直接地体现为不同参与群体及其个体享受着不同水平的基本医疗保障待遇。如何合理界定政府与市场在医疗保障中的主体责任,是我国医疗保险改革面临的迫切问题。它不仅直接决定着我国城镇医疗保险改革的进程与效果,也是多层次医疗保障体系的建立和以"全民医保"为目标的新一轮医疗保障制度改革的关键所在。

From a welfare pluralist perspective,which is a prevalent paradigm for social welfare and social policy analysis in the West in recent years,this paper analyzes findings from a survey focusing on issue of health insurance reform in urban China. It finds that the medical security provided varies enormously due mainly to various combinations among government,market and society. This means individuals as members of different social groups are entitled to basic medical security at very different level. How to define the responsibility of government and market in providing medical security will be critical to the health insurance reform in China. It is argued that such a defined role is not only determining the process and results of the reform,but also serving as a cornerstone for the establishment of a multi-level medical security system and the goal of the 'universal health insurance'.