城乡居民大病保险运行评析

The Evaluation on the Operation of the Supplementary Major Medical Insurance for Urban and Rural Residents

城乡居民大病保险实施迄今已满两年,全国29个省(市、自治区)出台地方实施方案。基于文献综述的方法,本文首先从制度设计层面辨析大病保险的制度定性、制度目标、保障内容、筹资机制、经办模式,进而评析大病保险的实施进展、取得的成效和存在的问题。总体而言,大病保险仅提升12%的实际支付水平,低收入人群的高额医疗费用负担仍然沉重,大病保险未能实现切实解决人民群众因病致贫、因病返贫问题的政策初衷。在全面推开大病保险之际,建议合理界定基本医疗保险和大病保险的边界,逐步拓展合规医疗费用,适度增加个人缴费责任,实施省级招投标和全省统一合同范本。

The Supplementary Major Medical Insurance for Urban and Rural Residents has been implemented for more than two years, with 29 provinces having published regional schemes. Based on literature search, this paper firstly analyzed the nature and the goal of the system, the financing mechanism and the operational model, as well as the operating model to evaluate the implementation process of the system. On the whole, the insurance scheme has just improved the real affordability by about 12%. The poor still face a heavy burden of medical costs, which means that the insurance scheme has not achieved the goal of protecting people from illness-induced impoverishment. As government decides to fully implement the Supplementary Major Medical Insurance, this paper suggested that gov- ernment should do more research on the system positioning of the scheme, gradually expand the reimbursable medi- cal expenses, moderately increase individual contribution, and conduct the bidding process and unify the contract at the province-level.