大病医疗保障制度的国际经验及启示

Catastrophic disease insurance system: International experiences and implications for China

为缓解重大疾病带来的沉重负担,国际上绝大多数发达国家都建立了不同模式的大病医疗保障制度,主要有商业医疗保险主导,国家医疗保险主导,社会医疗保险主导三种基本模式。考虑国际上典型国家的大病保障均以本国医疗保障制度为基础,本研究通过介绍三种模式下典型国家医疗保障体系的历史背景、制度框架等内容,分析其对重大疾病的保障模式与特点,总结各国在降低患者自付费用、控制医保付费水平、提高医疗服务质量和效率的相关经验,进而建议我国在制定大病保障政策时,注意采用综合控费措施,降低患者自付费用;转变医保支付方式,控制医保付费水平;加强运行监管,提高医疗质量和效率。

In order to mitigate the heavy financial burden of catastrophic diseases on the public, most devel- oped countries have established catastrophic disease insurance models, including commercial, national, and social insurance models. Typically, developed countries have a national medical insurance system that covers catastrophic diseases. We study the historical context and institutional framework of the general health insurance systems in devel- oped countries, analyze characteristics of different catastrophic disease insurance models and summarize the experi- ences in reducing patient out-of-pocket expenses, lowering insurance payments, and improving the quality and effi- ciency of medical services. When formulating policies about catastrophic disease insurance, governments should com- prehensively control medical costs to reduce patient expenses, change insurance payment methods to control insurance administration costs, increase operational supervision, and improve the quality and efficiency of medical services.