我国城乡居民医保筹资机制的完善思考——基于“三险合一”改革和结构性变革的探讨

Thinking of Perfecting the Financing Mechanism of Medical Insurance for Urban and Rural Residents in China——Based on the Discussion of "Integration of Three Basic Medical Insurance" Reform and Structural Change

我国城乡居民医保筹资机制的问题为制度财务可持续性和其对职工医保参保率的冲击问题。但相应的解决策略却难以解决根本问题。故而,本文认为应借"三险合一"改革契机,通过结构式变革方式解决城乡居民医保的筹资问题。因此,本研究首先述评我国城乡居民医保筹资机制当前面临的问题和解决思路;随后总结实现全民医保的转型国家中社会医疗保险制度筹资机制的特点,进而评价和讨论我国医保筹资机制的缺陷;最后,在"三险合一"背景下讨论筹资机制结构性变革的原则和关键问题。

The challenge of financing mechanism in the basic medical insurance for urban and rural residents can be attributed to the financial sustainability and its impact on participation rate of basic medical insurance for urban employees. However, the solution cannot solve the challenge. Therefore, this paper recommends that structural reform is needed, under the context of the integration of three basic medical insurance. Hence, this study reviews the challenges and solutions about current basic medical insurance for urban and rural residents financing mechanism. Then, summarizes the characteristics of universal coverage social health insurance financing mechanism in transition countries. After that, this paper evaluates and discusses the defect of financing mechanism in China, and finally, discusses the reform principles and key problems of structural reform.