我国医疗保险制度存在的问题及对策研究

Study of Problems of China's Medical Insurance System and Relevant Measures

我国新医改方案推行3年来,用最短的时间编织了世界最大全民医保网,但还存在着社会医疗保障供给与老百姓的医疗保障需求之间差距较大;社会医疗保险的责任范围较小;老百姓的医疗费用负担较重;医疗机构改革滞后等问题。为切实满足人民群众的健康需求,应在建立所有公民都享受全国平均水平的医疗保障体系,有效的实现社会公平和每个公民的健康保障权;本着"最基本的筹资水平、最基本的医疗服务"的理念,建立符合社会主义初级阶段的医疗保险费用筹措制度;在基本医疗的界定和选择上,采用国际上成本效果的评价方法和思想理念;建立行业管理、统筹规划的医疗保险管理体制,促进现代医疗市场的发育和完善;发挥政府、市场两个主体的作用,把商业保险作为对医疗保险的有效补充等方面扎实推进工作。

Since the implementation of the new medical reform for 3 years, the biggest network of national health care has been developed in a very short time. However, some problems remain unsolved： a large gap between the supply of social medical insurance and medical requirement of people, smaller range of responsibilities covered by social medical insurance, heavy burden of medical expenditure on people, the lag of medical institutions reform, etc. In order to meet the need of people keeping health, we shoud establish a medical care system for all people enjoying the service on national average, achieve fairness in the society and ensure that each person has rights to maintain health. Based on the concept of basic financing level and essential medical service, the paper proposes to establish a system of raising medical insurance expenditure, which should conform to the developing situation in the primary stage of socialism; adopt evaluation and concept of the international cost effectiveness to define and select the basic medicine; build health care management system characterized by medical management and overall planning to promote the development of modern medical market; through government and market playing their own roles, try to supplement commercial insurance into medical insurance.