全民医保视角下对职工医保制度的审视及建议

Review and Recommendations on Employee Medical Insurance System under Universal Health Care Perspective

通过对城镇职工基本医疗保险制度的审视,发现城镇职工基本医疗保险制度存在如下问题:(1)制度内容与"城镇职工"及"基本医疗保险"名称不相符合。(2)筹资制度存在企业单位及部分参保者缴费负担沉重;个人账户分流超过总量60%的医保基金,且构成反向补助;退休人员不承担缴费义务却有通过个人账户不当获利之可能。(3)效率低下且基金超支风险大。(4)制度覆盖范围内人员参保率低。建议:(1)在合并城镇居民基本医疗保险和新型农村合作医疗的基础上,构建统一的全民基本医疗保险。(2)取消城镇职工基本医疗保险制度,将城镇职工纳入全民基本医疗保险。(3)开征"医疗费附加税",用于设立医疗救助基金或直接补充全民基本医疗保险基金。(4)发展商业性医疗保险,构建全面的医疗保障体系。

Through viewing the employee medical insurance system, problems were found as below： （1） The content of system did not match the name of ＂urban workers＂ and ＂basic medical insurance＂. （2） In financing system, some business units and participated people had heavy burden; personal accounts shunt exceed 60% of the total health insurance fund and constituted a reverse subsidy; retirees did not assume the obligation of payment while they could obtain unjust enrichment through the personal accounts of the possible. （3） System inefficient and risky fund cost overruns. （4） Insurance coverage is low within tile system. Recommendations： （1） To build a unified national basic medical insurance based on merger residents and new rural cooperative medical insurance. （2） Abolish workers＇ medical insurance system, put urban workers into the universal basic medical insurance. （3） Introduce ＂medical expenses surtax＂, establish supplementary medical aid fund or direct universal basic medical insurance fund. （4） To develop commercial health insurance and build a comprehensive health care system.