福利资格、制度安排与福利结果——构建一个评估医疗保险财务风险保护机制的概念框架

Welfare Entitlement,Institutional Arrangement,and Welfare Outcome: A Conceptual Framework of Evaluating Financial Risk Protection of Social Health Insurance

社会医疗保险改革是中国医疗体制改革中的重中之重,那么医保改革如何影响人们的福利水平?在评估医疗保险和医疗费用的关系时,忽略医保制度安排的中介机制对医疗保险财务风险保护机制的分析便难以深入。从社会公民身份理论出发,结合福利制度安排相关理论,探讨医保资格获得对财务风险保护的影响,在此基础上构建评估医疗保险财务风险保护机制的概念框架。该框架分解了医保制度安排中的报销支付机制、就医行为调节机制和第三方购买机制,可用于评估医疗保险和医疗费用关系的实证研究。

Social health insurance reform is of paramount importance in the health care reform in China.There is a fundamental question in the process of reform, that is how health insurance may affect welfareoutcome. Previous work on the relationship between social health insurance and patients, health spending hasoverlooked the mediating mechanisms of the institutional arrangement. This study embraces social citizenshiptheory and institutional arrangement theory and establishes a conceptual framework of the institutionalarrangement to evaluate financial risk protection of social health insurance. It uses the reimbursement,behavior management and third-party purchasing mechanisms to elaborate on the institutional arrangement ofsocial health insurance, which may inspire future empirical studies that evaluate the effects of health insuranceon financial risk protection.