城乡居民大病保险可持续性分析

The sustainability analysis of catastrophic medical insurance for urban and rural residents

文章从筹资、待遇设计和组织管理三方面提出了大病保险政策可持续发展面临的问题,并结合政策背景、制度设计和治理体系等层次分析了制约因素。结论认为:大病保险政策已形成了基本的制度框架,但是,其在多层次保障体系中的保障边界模糊、在制度设计中存在先天缺陷与后天不足,且尚未形成有效运行的治理体系,因此,建议在未来政策制度化过程中,应逐步通过立法、科学测算以及进一步厘清政府和市场关系等措施来实现该项政策的可持续发展。

This paper puts forward the problems faced by the sustainable development of catastrophic medical insurance for urban and rural residents( CMIURR) from the aspects of financing,reimbursement design and organization management,analyzes the constraints on the basis of the policy background,institutional design and governance system,and comes to the conclusion that the basic institutional framework of CMIURR has been formed,but there are still some problems,for example,its benefit boundary of the multi-level medical security system is still unclear,there are defects and deficiencies in its institutional design,and its governance system has not yet been effectively operated. Therefore,it is suggested that in the process of policy institutionalization,the sustainable development of CMIURR is to be promoted by legislation,scientific measurement and further clarification of the relationship between the government and the market.