医疗保障城乡“一体化”制度创新探索——“湛江模式”的成功与不足

Innovation of an integrated social medical insurance system for urban and rural areas:success and weakness of Zhanjiang Model

"湛江模式"的创新要点是以"政府购买"方式引入商业机构参与城乡医疗社会保障建设,其成功之处在于政府以宽广的视野与多样化手段进行宏观资源配置,找到了将"外部性"因素进行"内部化"处理的途径,在机制设计中做到了多方共赢。"湛江模式"的不足之处是保障依然较低,机制能否长久良性运行有待时间检验,需要通过引入竞争机制,培育多元市场机构主体,提高政府宏观调控职能、优化政府服务行为等制度完善方式进行改进。

The success of ＂Zhanjiang Mode＂ lies with the adoption of ＂government purchase＂ to introduce commercial participation into the establishment of urban and rural social medical insurance system, in which the government ,with its broad outlook and resourceful methods, can properly allocate its medical resources,＂ internalize＂ the settlement of ＂external＂ issues, and achieve a multiple win in the mechanism design. The weaknesses of ＂Zhanjiang mode＂ are that the level of medical protection is still quite low, and in the long run, whether the mechanism work well remains to be tested. Improvement measures include introducing a competitive mechanism, cultivating a diversity of market participants, improving the macro control and service functions of government, and perfecting the medical support system and innovative mechanisms.