上海市基本医疗保险现状及问题分析：基于基本医疗保险与商业医疗保险协调发展视角

Analysis on the Current Status and Problems of Basic Medical Insurance in Shanghai: Based on the Coordinating Development Perspective of Basic Medical Insurance and Commercial Medical Insurance

上海市基本医疗保障体系相对健全,总体来看覆盖范围广、筹资水平高,但同时存在个人医疗负担较重、基金使用效率不高和医院普遍反映医保指标不足等问题,且不能保障各层次医疗服务需求。目前,上海市商业医疗保险发展空间相对受限,主要服务于高端客户群体,其专业性未得到充分发挥。发挥商业医疗保险的补充作用有助于完善基本医疗保障制度,同时可依托基本医疗保险的广覆盖来促进商业医疗保险的发展。

The basic medical security system in Shanghai was relatively complete with a wide coverage and high fund raising. Meanwhile, there were still existing problems limiting the demand for health service of different levels, including heavy individual medical burden, inefficiency of fund operation and insufficient medical indexes in hospitals. In current, the development of commer- cial health insurance was relatively limited. The main service was provided for top customer groups while its professionalism did play its role. The supplement of commercial medical insurance was essential to improve basic medical security system, while the wide cov- erage of basic medical insurance could help to promote the development of commercial health insurance.