基于罗尔斯正义论视角的城乡医保整合公平促进

Promotion of Fairness of Urban and Rural Medical Insurance Integration from the Perspective of Rawls's Justice Theory

改革开放以来,为适应经济社会快速转型,我国由新型农村合作医疗、城镇职工医疗保险、城镇居民医疗保险组成的缴费型基本医疗保险制度逐步构建。随着医保改革的持续深入和医疗保障事业的快速发展,我国当前已经形成了覆盖13.5亿人口的世界最大医疗保障体系,基本实现全民医保。但我国医疗保障体系仍然存在发展不平衡、不充分的现实问题,城镇居民医疗保险制度与新型农村合作医疗制度并轨整合正是破解这一难题、改善医疗保障、促进实质公平的必要途径。应用罗尔斯正义论审视城乡医保整合中形式导向的制度公平表象,能够促进优化医疗保障制度,为由形式导向的制度公平到结果导向的实质公平的过渡提供有益借鉴。

Since the reform and opening-up,in order to adapt to the rapid transformation of the economy and society,China has gradually constructed a payment-type basic medical insurance system composed of new rural cooperative medical care,urban employee medical insurance and urban resident medical insurance.With the continuous deepening of medical insurance reform and the rapid development of medical security cause,China has now formed the world's largest medical security system covering a population of 1.35 billion,basically achieving universal medical insurance.However,in reality,China's medical security system is still unbalanced and inadequate.The integration of urban resident medical insurance system and the new rural cooperative medical system is a necessary way to solve this problem,improve medical security and promote substantive equity.Applying Rawls's justice theory to examine the form-oriented system fairness in the integration of urban and rural medical insurance,we can find that the integration of urban and rural medical insurance system is able to promote the optimization of medical security system,thus providing useful references for the transition from form-oriented institutional equity to result-oriented substantive equity.