基于“4E”理论对单一保险人模式下全民医保分析——台湾地区健保制度的经验启示

Analysis of universal health insurance under the single-payer model based on“4E”theory:Experiences and implications from Taiwan health insurance system

本文根据“4E”理论,从经济性、效率性、效益性、公平性4个维度,基于台湾地区健保制度实践,客观分析单一保险人模式下全民医保制度优劣势,认为其短期内能够为所有人提供公平、可及且一致的给付项目和保障待遇,并能有助于降低管理成本和控制医疗费用的不合理增长;但长期内作为官僚体制产物的健保署对医药服务市场的不适当约束将会导致医疗服务或药品短缺,同时,单一的筹资渠道和相对固定的费率也难以避免财务危机的到来。建议大陆全民医保一体化改革中要充分发挥单一保险人的优势,规避劣势。

Based on the“4E”theory and inspired by practice of the Taiwan health insurance system,this article objectively analyzes the advantages and disadvantages of universal health insurance system under the single insurer model from the four dimensions of economics,efficiency,effectiveness,and equity.It is believed that this study can provide fair,accessible and consistent payment items and guarantees for all people in short period of time,and can help reduce management costs and control irrational growth of medical expenses.However,the improper restriction of health insurance agency on medical service market,which is a product of the bureaucracy in the long run,will lead to a shortage of medical services or medicines.At the same time,a single funding channel and relatively fixed rates also are the reasons for which it is difficult to avoid a financial crisis.It is recommended that the advantages of a single payer should be fully exploited to avoid disadvantages in the integrated reform of medical insurance system in China.