医保财政补贴的政府间责任分摊问题初探

Government liability for contributing into the premium subsidies for basic medical insurance

为新型农村合作医疗和居民基本医疗保险提供高比例的财政补贴,是我国财政支持医疗保险发展的关键举措。根据现行制度,每年的巨额财政补贴资金由中央和各级地方政府进行分摊。然而,由于政府间责任不明、缺乏制度化和长效化的政府间责任分摊机制,影响了医保制度公平和可持续发展。文章在对现状和问题进行分析的基础上,从理论方面对医保财政补贴的政府间责任分摊原则进行了剖析,然后结合居民人均可支配收入、人均消费支出、人均财政收入等因素,引入熵值法提出了中央财政补贴的五级分档思路,并基于"财政补贴指数"对省级及以下各级地方政府间的责任分摊提出了初步方案。相关思路和结论对于构建更加公平和可持续的医保财政支持机制具有重要意义。

The key policy for the Chinese governments to support the health insurance development has been to provide high percentage of premium subsidies in the 1. 1 billion Yuan insured for the two of the basic medical insurance systems. According to the current policy,governments should share the responsibility of several hundreds of billions Yuan of subsidies per year. However,because of the indistinct of the responsibility between governments at all levels and the shortage of systematic and long-term duty share mechanism,the current system has been directly affecting the fairer and more sustainable health insurance system development. Concerning these issues,this paper primarily thought about the contributory principle of subsides after analyzing the present situation and the main problems.Therefore,taking the three factors including disposable income per capita,consumption expenditure per capita and financial revenue per capita into account,it provides a＂5 steps approach＂about the contribution of the central government fiscal subsides using entropy evaluation method,and suggests a proposed program on the governments contribution liability at the provincial or decentralized level based on the ＂fiscal subsides index＂. Thoughts and conclusions drawn from this paper have a significant meaning into the establishment of a fairer and more sustainable financial support mechanism for the basic medical insurance.