城乡居民基本医疗保障制度改革引发的理论思考

A theoretical concern of urban-rural basic health insurance reform

本文阐述了我国目前"新型农村合作医疗与城镇居民基本医疗保险制度衔接"(简称"两制"衔接)的必要性、可行性以及当前"两制"并轨模式构想,提出了在"两制"并轨基础上建立城乡居民基本医疗保障制度的设计理念、制度内核以及管理模式选择。研究认为,我国现阶段"两制"并轨模式应该实行城乡"2+2"制度板块,即在以农业生产为主和农业人口占比重大的地区将城镇居民医保并入新农合,实行"新农合+城镇职工医保"两个板块模式的城乡居民基本医疗保障体系;在城市化发展水平较高或发展速度较快的经济发达地区,实行"城镇居民医保+城镇职工医保"两个板块模式的城市居民基本医疗保障体系。并指出城乡居民基本医疗保障制度的发展应从目前的医疗保险向健康保险过渡,基层医疗卫生服务与健康保险应该实行捆绑式运作。

This paper analyzes the necessity,feasibility and convergence model of New Rural Cooperative Medical Scheme（NRCMS）and Basic Medical Insurance of Urban Residents（convergence of ＂two health insurance institution＂）.The design concept,the core content and the selection of management model of urban-rural basic health insurance institution are suggested.It is concluded that the urban-rural ＂2＋2＂ institution model should be chosen to form a universal urban-rural basic medical security system.The Basic Medical Insurance of Urban Residents should be integrated into NRCMS in the areas where rural residents are the majority.In addition,the NRCMS should be integrated into Basic Medical Insurance of Urban Residents in the urbanized area which should implement the ＂Basic Medical Insurance of Urban Residents plus Basic Medical Insurance of Urban Employee＂ model,and its developing direction should realize transition from disease insurance to health insurance,and grass-root unit health services and health insurance should be bound.