基于证据的重特大疾病医保政策界定分析

Analysis on Evidence-based Defi nition of Catastrophic Illness in Social Health Insurance System of China

重特大疾病的医保政策界定,应基于医保制度目标,而非扩大化的社会责任和医疗职能,应在有限医保基金约束条件下,寻求如何体现基金使用公平、公正与高效的效果,以最优方式和路径完成其政策目标。对此,本文旨在通过政策实践分析,对重特大疾病医保的政策概念内涵与政策目标进行界定和分析,明确在医疗保障制度建设中,医保应如何更加有效地发挥基金的作用,保证医保健康高效运行,实现基本医保制度中重特大疾病保障的政策目标,体现制度的理性。

The defi nition of catastrophic illness in health insurance policy should base on its goals rather than expanded social responsibility and health care functions, should seek a way to use the fund fairly, justly and effectively under the constraints of limited medical insurance fund, and should take a optimal way to achieve the policy objectives. Through analysis on the practical experience, we defi ne the contents and goals of catastrophic illness in health insurance policy, and specify, in the construction of medical security system, how to use insurance fund more effectively and make insurance system running more efficiently to achieve the policy goal of basic medical insurance, and to refl ect the rationality in our insurance system.