中国医疗保障管理的制度演进、发展愿景及政策建议

The evolution,development vision and policy recommendations of China's medical security management system

2018年3月,新组建的国家医疗保障局成立,站在新的历史起点上,中国医疗保障事业面临新的机遇和挑战。本文通过回顾总结我国医疗保障制度的历史,以深刻理解和把握现阶段中国医疗保障管理制度的历史方位,根据管理体制和归口部门的不同,大致可以将中国医疗保障管理的制度演进分为3个阶段,即:卫生部门管理为主阶段(1949-1998年)、劳动和社会保障部门管理为主阶段(1998-2018年)、医疗保障局管理为主阶段(2018年以来)。文章提出中国医疗保障制度的发展愿景,一些更深层的问题有望在国家医疗保障局成立后能够得以解决,主要是解决多层次医疗保障体系的短板问题、重启和强化第三方购买机制、解决决策机制的异化问题、厘清商业保险与社会保障的关系问题等。为实现发展愿景,本文提出5个方面的政策建议,包括:促进职能有机整合、形成三医联动合力,强化政府调控、完善市场运作,搭建不同制度的连接机制,强调扶贫格局、聚焦公平视角,发展"互联网+"医保。

In Mar. 2018,State Medical Security Bureau was established. Standing at new historical starting pointing,China's medical security is facing new opportunities and challenges. By reviewing and summarizing the history of China's medical security system,this paper pays keen appreciation and holds historical orientation of China's medical security system at this stage. The evolution of China's medical security management system can be divided into three stages according to different management systems and relevant departments,that is,the management of health sector was main stage(1949-1998),as well as the management of labor and social security(1998-2018),and as well as the management of Medical Security Bureau(2018-). The article puts forward the development prospect of China's medical security system. Some deeper problems are expected to be solved after the establishment of State Medical Security Bureau. They are mainly to solve the shortcomings of multi-level medical security system,restart and strengthen the third-party purchase mechanism,solve the alienation of decision-making mechanism,and clarify the relationship between commercial insurance and social security. In order to realize the vision of development,this paper puts forward five policy proposals,such as promote functional integration,form three medical linkage forces,strengthen government regulation and control,improve market operation,build up connection mechanism of different system,emphasize poverty alleviation pattern,focus on fairness,and develop “Internet +” medical insurance.