基于卫生总费用的医疗保障体系保障能力测算分析

Analysis of the Insurance Ability of Medical Insurance System Based on THE in China

为了解我国医疗保障体系的保障能力现状,并根据医疗保障体系的组成与设计的实际情况,本研究从各保障制度的覆盖人数测算保障体系的覆盖程度、医疗保障总费用及社会医疗总费用测算保障体系的补偿水平、综合覆盖程度与补偿水平测评我国保障体系的保障能力等方面进行探讨,提出2010年我国医疗保障制度应覆盖有95%的人口,在各种保障制度不同的保障方式下,个人医疗费用平均自付49.49%,保障体系补偿比例为50.51%。同时,在我国保障制度的覆盖面逐步提高,全社会保障体系补偿总量稳步提升,补偿水平呈逐年下降趋势,但居民实际支付的医疗费用仍在上升的情况下,建议我国保障体系的深化方向应由提高覆盖面转向提高补偿水平,以进一步提高保障居民的受益程度。

Based on the composition and the design of the Medical Insurance System in China（MIS）, Its insurance ability was explored. Est- imates the coverage based on the population of coverage in MIS, estimates the level of compensation based on the total medical compensations and the total medical costs, Combined the coverage with the level of compensation evaluate its insurance ability. 95% of the population is covered in MIS in 2010. Each person pays 49.49% of individual medical expenses on average in the whole society, the compensation ratio of MIS is 50.51%. The coverage of MIS increased gradually, the total compensation of MIS increased steadily, the level of compensation is on a declining trend. But the actual payment of medical expenses of residents is still rising, the direction of the deepening of MIS should be turned to raise the compensation level replaced improving the coverage to further improve the benefit of residents