我国城镇职工基本医疗保险的道德风险及其防范

Moral Risks of Urban Employee Basic Medical Insurance and Prevention.

通过江苏省镇江市等城市多年的医改实践表明 :城镇职工基本医疗保险中存在着道德风险 ,其主要原因 :一是基本医疗水平较高 ;二是基本医疗保险覆盖面较窄 ;三是医保规定不完善 ;四是部分参保单位上缴基金不足等造成医保资金的流失。据此笔者提出 :建立低水平、广覆盖的多层次的补充医疗保险 ;进一步完善医保基金的筹资和管理方式 ;建立有效的个人筹资和医疗费用分担机制等 。

The practices of reform of medical insurance carried out in Zhenjiang and other cities during past years show that there are moral risks in urban employee basic medical insurance that cause the drain of fund. The main reasons are: (1) the level of basic medical service is higher; (2) the coverage of basic medical insurance is narrow; (3) graduations of medical insurance are not perfect; (4) some units can't turn over enough premium. The authors put forward some suggestions to reduce the moral risks to a minimum that it should establish a complementary medical insurance that is low level of medical service, wide coverage and multi-level, further perfect medical insurance financing and management, and establish effective individual financing and system of medical expense sharing. Authors′address Zhenjing Medical College, Zhenjiang, Jiangsu Province, P.R.China.