医疗保险经办机构之法律定位——论社会行政给付主体之角色与功能

Legal Orientation of Medical Insurance Agency——On Role and Function of Social Executive Prestation Subject

医疗保险经办机构作为法律法规授权的组织,在"管理与被管理"的法律关系中立于管理者的地位。然而,在给付国家背景下,公民应立于"权利主体"而非"被管理者"的地位对国家享有社会给付请求权。在公民与国家间以"请求给付权利——给付义务"为内容的抽象法律关系具化为公民与特定给付主体之间的具体法律关系后,给付主体就不应仅为享有行政权力的管理者,同时亦应成为给付义务的承担者。在医疗保险法律关系中,给付义务主体应当是对医保基金运营具有独立权利能力的保险人。基于此,我国医保经办机构应当从确立独立性、健全职能、强化能力等方面朝向保险人方向予以塑造。

As the organization authorized by laws and regulations, the medical insurance agency stands as the administrator in the legal relationship between ＇administrating and being administrated＇. However,under the background of the prestation country, citizens should stand as the ＇subject of right＇ instead of ＇the administrated＇ to enjoy the claim right of social prestation towards the country. After concretization of theabstract legal relationship between citizens and the country taking ＇claiming for prestation right --prestation obligation＇ as its content to the concrete legal relationship between citizens and the specific prestationsubject, the prestation subject should not only act as the administrator enjoying executive power, but also the undertaker of prestation obligation. In the legal relationship of medical insurance, the subject of prestationobligation should be the insurer who has independent right capacity to medical insurance fund operation. Based on this, China＇s medical insurance agency should be modeled towards the direction of insurer from aspects ofindependence feature establishment, function perfection, capacity strengthening, etc.