天津市基本医疗保险制度公平性评价

Equity evaluation on the basic medical insurance system in Tianjin

目的:对天津市基本医疗保险制度的公平性进行评价,分析公平性方面存在的问题。方法:从横向和纵向两个方面评价天津市基本医疗保险制度的公平性,横向采用参保、筹资、医疗服务利用公平性等指标评价,纵向分析人口老龄化和现收现付制,以及个人账户对医疗保险公平性的影响。结果:参保机会、城乡居民筹资较公平;不同收入人群间的基金筹集、职工实际筹资负担率、城乡居民医疗服务利用、代际之间以及个人账户方面存在一定的不公平。结论:继续扩大医保覆盖范围,根据收入差异制定不同的缴费额、起付线和封顶线,完善社区卫生服务体系,逐步建立和完善老年护理保险制度,取消退休人员的基本医疗保险个人账户。

Objective： To evaluate equity on the basic medical insurance system in Tianjin,and further analyze the existing problems. Methods： To assess the equity from horizontal and vertical aspects. The horizontal equity evaluation indicators include equity on the insuring,financing and the utility of medical service; while the vertical ones include population ageing,pay-as-you-go（ PAYG system） and the impact of health insurance on individual accounts equity. Results： The insurance opportunities,and urban and rural residents financing are more equitable; fund raising among different income groups,actual funding burden rate,medical service utilization between urban and rural residents,and aspects of generations and personal accounts are comparatively unfair as well. Conclusion： This paper proposes to further expand medical insurance coverage,make different contributions,deductible and ceiling lines based on different income groups,improve community health service system,gradually establish and improve elderly care insurance system,and cancel the retiree basic medical insurance personal accounts.