我国基本医保管理体制整合的困境与反思

Dilemma and Reflection on the Integration of Basic Medical Insurance Management System in China

合理的管理体制既是提升医保制度运行效率的有效途径,也是促进制度公平的必然要求。通过追溯医保管理体制形成的历史根源并梳理整合面临的困境,指出部门之间的利益之争是阻碍整合的主要因素。在辨析医保主管权归属的不同理论分歧基础上,明确统合型管理体制是未来制度改革的方向。基于医疗保险制度兼具社会保险与卫生体系的双重属性,由人社部门或卫生部门行使主管权皆具有合理性,但基于医疗行为规制和医改联动的角度,由卫生部门统一行使是一种更优选择。

Reasonable medical insurance management system is not only an effective way to improve the operation efficiency,but also an inevitable requirement to promote the equity of the whole system.By tracing the historical roots of the medical insurance management system and sorting out the predicaments in the integration process,it points out that the conflict of interests between departments is the main factor hindering the integration.On the basis of differentiating the theoretical differences on the ownership of the medical insurance authority,it clarifies that the integrated management system is the future direction of medical insurance reform.In view of the double attributes of medical insurance system from social insurance and health system,there is a certain degree of rationality for the exercise of executive power by social security department or the health departments.However,based on the regulation of medical behavior and the linkage of medical reform,exercising unified administrative right by the health department may be a better choice.