医疗保险法治建设的意义、难点与前景

Signifi cance, Difficulties and Prospects in the Construction of the Legal System of Medical Insurance

医疗保险涉及主体多、关系复杂,始终存在道德风险、利益博弈,需要专门立法,及时制定《基本医疗保险条例》,以保障制度的公平和可持续发展。但立法也面临不少难题:医疗保险制度分设、管理分割,基本制度尚未定型;有的改革举措与社会保险法规定不一致;对筹资模式、缴费费率、个人账户、待遇水平、定点管理、法律责任等问题需认真研究论证。建议人力资源和社会保障部认真总结改革经验,抓紧形成新的《基本医疗保险条例(草案送审稿)》,争取尽快将其列入国务院立法计划。

Medical insurance system is so complicated that formulating Regulations of Basic Medical Insurance specially is needed to ensure a fair and sustainable development of the insurance system. However, the regulations drafting process is relatively slow in China due to the following reasons： the medical insurance system is fragmented and the design of the medical insurance system has not been fi nalized; there are some contradictions between the reform measures and the stipulations of the Social Security Law; some key issues, such as fi nancing mode, premium rate, individual account, treatment level, management of designated hospitals and pharmacies, legal liabilities, should be discussed and analyzed seriously. It is suggested that the Ministry of Human Resources and Social Security should draft a new Regulations of Basic Medical Insurance as soon as possible to make it included in the legislative plan of the State Council.