全民健保战略目标下的医疗救助理念研究——浙江省新型社会救助体系的启示

Research on the Concept of Medical Assistance under the Aim of Establishing the Health Care System through Universal Coverage——Enlightenment from the New Social Assistance System in Zhejiang

在全民健保的战略目标下,医疗救助的地位被弱化,只是对因病致贫人员和特殊群体实行的临时性救助。然而,以缴费型保险为主的医疗保障体系不能从根本上解决贫困人口的医疗费用问题。因此,从目前过渡到全民健保阶段,医疗救助的地位不应该被削弱。目前我国医疗救助的理念定位不清,没有充分化解贫困人口的疾病风险。本文以全民健保的战略目标和医改为背景,对基本风险、最低需求、政府责任这几个基本概念加以界定;并从医疗救助化解的社会风险出发,分析全民健保战略目标下仍需医疗救助处理的基本风险;再以浙江省分层分类的覆盖城乡的新型社会救助体系为例,阐述医疗救助理念定位需要重点解决的两个关键问题,反思医疗救助与社会医疗保险的关系和医疗救助水平,促进公平和效率。

According to the strategic aim of establishing the health care system through Universal Coverage,the status of medical assistance will be weakened.Medical assistance is designed only for people whose poverty caused by diseases and other special group.However,the medical security system which is dominated by social insurance cannot solve the problem of medical expenditure for the poor radically.Therefore,medical assistance will still play an important role until the health care system through universal coverage is established.At present,the medical assistance does not fully defuse disease risks,because of the unclear concept of medical assistance.Based on the aim of establishing health care system through universal coverage and medical reform,this paper defines some basic concepts,such as the basic risk,the minimum demand and government responsibility.Then starting with the social risk defused by medical assistance,it analyses the basic risk which still should be defused by medical assistance when realizing the aim.Taking the new social assistance system which covers urban and rural in Zhejiang for example,this paper discusses two key problems when the concept of medical assistance is positioned,for promoting equity and efficiency.