重构医疗保险体系 提高医保覆盖率及保障水平

Reconstructing the Medical Insurance System to Improve Coverage and Level of Protection

在顶层设计的思想下,中国基本医保的问题是离人人有保障的距离较大;新型农村合作医疗筹资水平和保障水平较低;城镇内部医保制度碎片化,一家多制问题突出,尤其是城镇居民基本医保的保障能力比新型农村合作医疗更低;同时职工医保个人账户资金效率损失严重。为此,提出重新构建基本医保体系:短期目标是城镇三网合一,取消职工医保个人账户,就业者缴费,全家得保险,建成强制性城镇基本医疗保险体系及农村基本医疗保险体系;中期目标是宽容城乡二元并行,建立农村保费增长速度较高的机制;长期目标是当真实城镇化率达70%～80%时,实现城乡医保的一体化。

This paper argues that China＇s basic medical insurance systems under the ideology of top- level design, coverage for all is far away ; the level of the New Rural Cooperative Medical Scheme （NRCMS） financing and the level of protection are relatively low; fragmented urban internal system, highlights the multi- system problem, especially residents in Medicare support capacity is lower than the NRCMS; at the same time serious loss in capital efficiency of employee＇s medical insurance individual accounts. This paper presents a re- construction of the basic medical insurance system： short-term unification of the three nets in Cities and towns, cancel personal accounts of employees＂ medical insurance, employees contributions, entire family must be insured, completion of mandatory basic urban medical insurance, completion of basic rural medical insurance, in the medium term tolerate a parallel urban-rural dual, establish a relatively high premium growth rate mechanism in rural areas; when real urban rate reaches 70%-80%, natural integration of urban and rural medical insurance is achieved.