我国基本医疗保障制度发展程度的定量研究:全民统一健康覆盖的混合模型

Quantitative Study on the Development of Basic Medical Insurance Schemes in China:A Mixed Model Based on Universal Health Coverage

目的:基于全民统一健康覆盖的视角,构建模型,定量评价我国基本医疗保障制度的发展程度。方法:从制度覆盖人口比例、保障内容、保障程度、基金统筹层次和制度唯一性等五方面构建测量模型,定量分析2003—2015年我国基本医疗保障制度的发展程度,并进行灵敏度分析。结果:模型揭示,2003—2015年我国基本医疗保障制度的发展程度逐年波动,在百分制的得分区间内,2003年得分为52.20%,2006年为28.50%,2010年为23.90%,2015年为26.50%。基本医疗保障制度的数量对结果影响最为显著,其次为基金统筹层次。结论:混合模型的构建为测量全民统一健康覆盖提供了新的计量评价工具,与以前构建的乘法模型、加法模型共同组成了完整的评价工具箱。我国基本医疗保障制度发展任重道远,发展重点应当是整合三项基本医疗保障制度并统一待遇、提高基金统筹层次至省级和国家级。

Objective： Based on the perspective of Universal Health Coverage（UHC）, a mathematical model was developed to conduct quantitative study on the development status of Basic Medical Insurance Schemes（BMIS） in China. Methods： A mixed model was developed to conduct quantitative study on the development of BMIS in the period of 2003-2015 from five dimensions： coverage of population, benefit package, reimbursement rate, risk pooling level and unity of the schemes. Sensitivity analysis was also performed. Results： The UHC scores for BMIS in China from 2003 to 2015 fluctuated obviously. Given the range of 0-100 percent, the UHC score in 2003 was 52.2% , 28.5% in 2006, 23.9% in 2010 and 26.5% in 2015. The integration and equalization of BMIS and scaling up the risk pooling levels were shown to contribute significantly to UHC. Conclusion： The construction of mixed models was developed to provide a new calculation assessment tool for measuring the UHC, which consisted of completed evaluation tool package with addition model and multiplication model. Considering the future development of UHC, there is a still long way to go for BMIS in China. Emphases should be given to integration and equalization of BMIS as well as scaling up the risk polling to provincial and na- tional level.