医疗保险法治化的法理探讨和对策建议

The Jurisprudential Discussion and Suggestions on Legalization of Medical Insurance

医疗保险法治化除有"良法善治"的法治化一般要求外,具体的基本要素还应当包括明确的权利义务主体、明确的医疗保险基金来源和使用规则、完善的权利保障机制和明确的法律责任规范。当前我国的医疗保险制度存在着立法位阶低、法律规范粗疏,制度公平性不足,待遇水平偏低等问题。影响医保法治进程的深层原因在于社保理念的落后以及可持续发展理念的缺失,需要在解决立法碎片化,完善社会保险基金法律制度,完善多支柱的社会保险法律体系,探索制度创新以妥善应对社会转型中新增的社会风险等方面着力,实现医疗保险法治化建设的攻坚克难。

In addition to the basic requirement of “Ruled by Law”, there are some other specific characteristics when it is applied to the medical insurance area, which are the clarified subject of rights and obligations, clari？ ed rules of collecting and using of medical insurance fund, sound safeguard mechanism of rights and clari？ ed rules of liabilities. Currently the problems in our medical insurance system are the low legislative level, rough and immature statues, inequality of rules and systems, and insu？ cient treatment and payment. The mean reasons behind are the old-fashioned idea of social insurance and sustainable development. Breaking the “bottleneck” of legislation and the barrier between professionals and residents insurance systems, improving the mechanism of social insurance fund, developing multi-pillar social insurance system, and exploring innovation in systems dealing with risks following the social transformation would be the ideal counter measures to solve the problems in the construction of legalized medical insurance system.