摘要
构建统筹城乡的医疗保障制度体系是新医改的重要任务之一,广东省湛江市积极探索将商业保险引入城乡社会医疗保险的新模式,引起广泛关注。本文建立了湛江实践的理论分析模型,其实质是通过增值再保险的方式,将医保基金部分支付和管理职能外包给商业保险机构,形成了"一次投保+二次分保+第三方协同管理"的城乡一体化健康保障模式。与其他地区实践相比较,湛江以较小的成本和代价确保了制度平稳衔接,提高了城乡居民医疗保障水平,但也存在合法性争议、管理外包风险、经营目标冲突等局限性,能否实现突破是该模式可持续的关键。
Integrated urban and rural social health system is an important task of Chinese new medical reform.This paper establishes a theoretical model to investigate the case of ZhanjiangCity where is underdeveloped in GuangdongProvince.The innovation of Zhanjiang's practice is by introducing reinsurance,outsourcing service with commercial company to take partly responsibility of social health fund obligations to improve medical security level under less cost.However,problems such as legality disputes,outsourcing risk,profit limitations ete will affect its sustainability.
出处
《农业经济问题》
CSSCI
北大核心
2014年第2期95-101,112,共7页
Issues in Agricultural Economy
基金
国家社科基金项目(编号:13CGL138)
