中国城乡医保“碎片化”建制的路径依赖及其突破之道

The “Fragmentation” Path Dependence and Breakthrough Road of Chinese Urban and Rural Medical Insurance System Construction

改革开放以来,基于计划经济体制下"一个国家、两种福利"城乡医疗保障"碎片化"建制的路径依赖,适应市场经济体制的、"渐进性"改革和建制的城乡基本医疗保险制度无以摆脱体制性、结构性、补丁式的"碎片化"特质。缘起于21世纪初的地方自发探索整合城乡医保制度,囿于城乡一体化不均衡发展、地方试验的选择性以及整合政策的上下不协调,强化了城乡医保的"碎片化"建制程度,不但"整而未合",甚至陷入"再碎片化"悖论。为了突破城乡医保"碎片化"建制的路径依赖,必须从根本上进行体制性改革,建立统一的医保"大部制"管理体制,以体制整合带动机制整合,并设计法制化的整合型城乡医保制度,自上而下推进城乡医保制度全面整合。

Since China＇s reform and opening up, urban and rural medical insurance system cannot get rid of institutional, structural, patch type ＂fragmentation＂ characteristics because of depending on the medical security ＂fragmentation＂ path of ＂one country, two kinds of benefits＂ under the planned economy system. At the beginning of new century, the place started to explore the urban and rural medical insurance system integration spontaneously, which strengthened the degree of ＂fragmentation＂ system construction of urban and rural medical insurance and even made it into a ＂fragmented＂ paradox because of urban-rural integration not balanced development, local selected test and integration policy of central and local not harmonious. In order to break through the ＂fragmentation＂ path dependence, it is necessary to carry out institutional reforms, which includes in establishing a unified ＂big medical insurance＂ management system first, driving operating mechanism integration and designing legal integrated urban and rural medical insurance system to comprehensively integrate the urban and rural medical insurance system from top to bottom.