政府医疗保险责任划分探讨

The Research on the Division of Governmental Responsibility in Health Insurance

政府医疗保险责任包括制度设计、运行监管、资金支持。责任划分首先是政府与市场之间的划分:医疗保险基金自我平衡是其与政府财政责任的边界,政府作为最后责任人承担医疗保险运行失衡的财政托底责任。其次是政府体系内各级政府之间的划分。基金抵御风险的能力、道德风险的控制、异地就医即时报销的民意,三种力量决定中国医疗保险应选择"市级基金平衡+政府三级账户联网"管理模式。

The responsibilities of government in health insurance include system design, operation supervision and financial support. Firstly, the division of governmental responsibility in health insurance begins with that of government and market： the homeostatic principle of health insurance fund is the boundary of governmental fiscal responsibility, and the government is the last person in charge of the health insurance fund imbalance. Secondly, it is the division within different levels of government system. Three factors, which include the ability of the fund to resist risks, the control of moral hazard and the desire of immediate reimbursement of remote medical care, determine the model of ＂Municipal level fund balance ＋ Governmental three-level accounts network management＂ in Chinese health insurance system.