大病保险对家庭灾难性医疗支出的风险分散机制分析

The effect of catastrophic medical insurance on the risk diversification of the household catastrophic health expenditure

本文以大病保险制度的构建目标为出发点,通过实际受益人群规模来评估大病保险家庭灾难性医疗支出的风险分散效果。本文认为,我国大病保险制度提出的灾难性医疗支出标准偏高并且统一,可能导致大病保险的实际受益人群有限,风险分散效果不足。建议应进一步细化灾难性医疗支出的标准,采纳世界卫生组织提出的占家庭非食品消费高于40%的标准,并从多渠道筹资机制、合理控制医疗费用、保险公司提升服务水平等方面完善大病保险制度的风险分担机制。

This paper analyses the risk diversification of the household catastrophic health expenditure based on the scale of people who can benefit from the catastrophic medical insurance. It concludes that the sole criterion of catastrophic health expenditure used is too high to benefit a lot of people. Then this paper suggests that we should im- prove the criterion based on the income and accept the criterion of catastrophic health expenditure of WHO, which is 40% of non-food household expenditures. Besides this paper suggests that we should update the health financing strategy, control the growing of medical cost, improve the managerial service of insure to development a cost sharing risk mechanism.