对中国基本医疗保险范畴界定的再研究

A Restudy on the Definition of the Scale of Basic Medical Insurance of China

本文是一个对中国基本医疗保险范畴界定的再研究。经过生理学、临床医学、保险学和经济学等角度的详尽分析 ,我们认为现行的根据医疗费用高低和医疗具体项目范畴的标准来确定中国基本医疗保险范畴的做法不尽合理 ,容易加剧医疗消费的道德风险和导致医疗资源的巨额浪费。本文的分析结论是 :合理的基本医疗保险应界定在急、危重症的范畴之内。

The paper restudies the scale of basic medical insurance of China. Through detailed analysis from the angles of physiology, clinical medicine, insurance and economics, we hold that the actual pracitice of deciding the scale of basic medical insurance of China according to the current standard based on the level of medical expenditure and the scale of actual medical project, is not absolutely proper, for it is subject to enlarging ethical risk of medical expenditure and resulting in great wastes of medical resources. After analysis, we reach the conclusion that rational basic medical insurance should be defined in the reach the conclusion that rational basic medical insurance should be defined in the realm of emergency cases, serious illnesses as well as fatal illnesses.