基本医疗保险财政补贴的政府间责任分摊研究

A Study on the Government Financing Responsibility Sharing Mechanism of China’s Social Health Insurance System——Based on the Perspective of Equalized Transfer Payments

在我国现行基本医疗保险体系中，财政补贴是城乡居民医保的主要筹资来源，每年数千亿元的财政补贴由中央和各级地方政府分摊。但是，仅仅区分东、中、西部的“一刀切”式的责任分摊机制，未能充分考虑到地区间的补贴需求差异和财政支付能力差异，从而影响了筹资稳定性和医疗保障均等化的目标实现。为此，我们借鉴均衡性转移支付的分配理念与方法，建立了基于“标准补贴需求”、“标准补贴供给”和“补贴需求差异系数”的测算框架，通过引入“因素法”对各省的“补贴需求差异系数”进行估计，并将其作为中央财政补贴均衡性分配的关键变量，得出中央和各省级地方政府之间的责任分摊比例。在此基础上，将全国31个省划分为“自力更生”、“中央适当扶持”，“中央大力扶持”、“中央重点照顾”和“中央依赖”等五个补贴类型。最后，对未来五年的政府间责任分摊比例进行了预测。

In our social health insurance system, financial subsidies arc the main source of fund-raising for the Urban and Rural residents ＇health insurance. Each year as much as hundreds of billions of subsidies are shared by the central and local governments. However, the ＂one size fits all ＂responsibility sharing mechanism, which just based on the eastern, middle and western partition, does not adequately consider the differences of subsidy demand and the capability to pay among local governments. As a result, it will influence the stability of fund-raising and is standing in the way of accomplishing the goal of health care equality. Borrowing the idea and method of equalized transfer payments, this paper established a calculating frame premised on the newly introduced concepts of＂standard subsidy demand＂, ＂standard subsidy supply＂ and ＂difference coefficients of subsidy demand＂. Under this fraznework, by applying the ＂factor method＂, the ＂difference coefficients of subsidy demand ＂for each province are estimated and used as the key variable to calculate the proportions of the financing responsibility between central and provincial governments. And on this basis the paper categorizes the 31 provinces into five groups including ＂self- reliance＂, ＂properly supported＂, ＂strongly supported＂, ＂primary targets＂and＂central government-reliance＂. Finally, the paper predicts the financial proportions between two levels of governments in the coming 5 years. The thoughts, method and conclusions the paper reveals have a significant meaning to establish a more fair and effective government financing responsibility sharing mechanism for the health insurance system.