医保筹资与职工医保个人账户权益置换改革

Equity Replacement Reform of Medical Insurance Financing and Worker Medical Insurance Personal Account

本研究证明,目前我国职工社会医疗保险筹资在合理区间内,几乎没有增长空间。医疗保险进入存量改革和结构式发展阶段,要以健康为中心,在尊重临床路径的前提下,促使医保基金在社区医疗、专科门诊和住院间合理配置,提高基金使用效率。现行职工医保个人账户支付门诊费用的制度安排难以满足不断增加的慢性病管理和保障需求。本文基于帕累托改进福利经济学原理,提出用职工医保个人账户支配权益置换门诊统筹慢病保障权益的改革路径,并通过实证分析和数据证明置换速度的帕累托最优和置换人群的帕累托改进效果。最后提出加强教育优先、渐进式改革、加强绩效考核与高起点建立门诊共济保障机制的建议。

This study proves that there is little room for growth in the fi nancing of social medical insurance for employees in a reasonable range.In the stage of storage reform and structural development,medical insurance should take health as the center.On the premise of respecting the clinical pathway,we should promote the reasonable allocation of medical insurance fund in community medical care,specialist outpatient and inpatient,and improve the effi ciency of fund utilization.It is diffi cult to meet the increasing demand of chronic disease management that the current system arrangement of personal account of medical insurance for employees to pay outpatient expenses.Based on the principle of Pareto Improved Welfare Economics,this paper puts forward the reform path of replacing the outpatient pooling of chronic disease with personal account of medical insurance for employees.And through empirical analysis and data,it is proved that the Pareto Optimal of replacement speed and the Pareto Improvement Eff ect of replacement population.Finally,it puts forward some suggestions,such as strengthening education priority,gradual reform,strengthening performance evaluation and establishing outpatient pooling system from a high starting point.