中国基本医疗保险的实际参保率及其分布特征:基于多源数据的分析

The Effective Coverage Rate and Distribution Characteristics of China’s Basic Medical Insurance:Analysis Based on Multi-source Data

全民覆盖是基本医疗保险降低国民医疗费用负担的前提条件。中国基本医疗保险是否实现了全民覆盖仍存在争议。本文利用多源调查数据,分析了我国基本医疗保险实际参保率及其分布特征。不同来源的数据基本证实,2015-2016年,中国仍有超过10%的国民没有参加任何一项基本医疗保险制度。其中,城镇居民、非农户口和没有户口的居民、东北地区、年轻人、儿童、未就业人群、低收入人群、在校学生以及流动人口基本医疗保险实际参保率更低。城乡居民实行自愿参保,因管理部门分割、信息系统不统一导致的重复参保以及因财政补贴制度导致的户籍地参保等制度设计,是导致基本医疗保险未能实现全民覆盖的根源。要实现基本医疗保险全民覆盖,解决国民医疗后顾之忧,未来我国基本医疗保险应实行强制参保、以家庭为单元参保、常住地参保,建立全国统一的基本医疗保险信息系统,并鼓励发展补充性医疗保障制度。

Universal coverage is a prerequisite for basic medical insurance to reduce people s burden of medical expenses.Whether China’s basic medical insurance has achieved universal coverage remains controversial.This paper analyzes the effective coverage rate and distribution characteristics of basic medical insurance in China using multi-source survey data.Data from different sources largely confirms that in 2015-2016,over 10% of the whole population was still not covered by basic medical insurance.Among them,urban residents,non-registered residents,people in northeast China,young people,children,unemployed people,low-income people,school students and the migrating population had a lower coverage rate.Barriers to achieving universal coverage include:(1) the residents’ scheme is on a voluntary basis;(2) repeat enrollment caused by a segmented administration and information technology(IT) system;(3) residents can only be insured in their places of household registration due to policies for government subsidies.To achieve universal coverage and alleviate people’s worries and concerns about costs of illness,it is advisable to introduce compulsory and family-based insurance,provide coverage in permanent places of residence,establish a unified IT system,and encourage supplemental health insurance.