美国托底性医疗保障:体系阐释、制度评估与经验启示

The Bottom Line of Medical Security in America:System Interpretation,System Evaluation and Experience Enlightenment

托底性医疗保障是满足贫困家庭基本医疗保障需要、建设多层次医疗保障制度体系的重点内容。以商业医疗保险为重要特点的美国,却建立了规范、齐整、有效的托底性医疗保障体系,其制度经验值得研析。基于可行能力理论,结合社会保护底限的内涵,文章构建了包括制度目标、制度设计和制度效能三个层面、九个维度的托底性医疗保障政策分析框架,并在此基础上,重点对美国托底性医疗保障的直接制度基础以及基本医保中内嵌的托底保障功能进行了介绍和评价。最后,在分析美国经验和不足的基础上,文章归纳启示并提出了我国托底性医疗保障应明确覆盖全员和多样化托底保护的制度目标,优化多重保障、权责清晰、管理流畅的制度设计,并通过强化托底倾斜、融入预防和投资功能改善托底性医疗保障的制度效能等政策建议。

The bottom line of medical security is the key content to meet the basic medical security needs of poor families and build a multilevel medical security system.However,the United States,which is characterized by commercial medical insurance,has established a standardized,complete and effective last line medical security.Its system experience is worthy of analysis.Based on the theory of feasible ability,combined with the connotation of social protection threshold,this paper constructs a policy analysis framework of underpinning medical security,which includes three levels and nine dimensions of system objectives,system design and system efficiency.On this basis,this paper analyzes the Medicaid and CHIP,which is the direct system foundation of underpinning medical security in the United States,and evaluates the functions of underpinning medical security embedded in and Medicare and BHP.Finally,based on the analysis of the experience and shortcomings of the United States,this paper summarizes the relevance to China,and suggests that China’s basic medical security system should clearly cover the whole staff and diversify the system objectives of basic medical security,optimize the system design of multiple security,clear rights and responsibilities,and smooth management,and improve the system efficiency of basic medical security by strengthening the basic tilt,integrating the functions of prevention and investment.