基于多源流理论视角的职工医保个人账户的政策变迁分析

Analysis on the Policy Change of Individual Account of Employee Medical Insurance:Based on the Perspective of Multi-source Flow Theory

目的:阐释城镇职工基本医疗保险个人账户的政策变迁机制,以探寻其未来改革发展的方向。方法:运用多源流模型分析城镇职工基本医疗保险个人账户改革的必要性和合理性,找出其政策变迁可能引发的问题。结果:政治源流主导此次政策变迁,可能引发相关利益冲突,增加统筹基金保值增值压力以及统筹层次难以适应改革等问题。结论:应以弱化城镇职工基本医疗保险个人账户作为进一步改革取向,采取拓宽个人账户使用范围、提高医保统筹层次和探索门诊统筹等措施,进而推动城镇职工基本医疗保险制度的可持续发展。

Objective:To explain the policy change mechanism of employee medical insurance individual account,and to find the strategies for its future reform and development.Methods:Multi-source model was used to analyze the necessity and rationality of individual account reform of employee medical insurance,and to find out the possible problems caused by policy change.Results:The political dominates the policy change,which may lead to conflicts of interest,increase the pressure of maintaining and increasing the value of pooling funds,and difficulty in adapting the pooling level to the reform.Conclusion:It is needed to take weakening measures as the orientation of further reform,such as widening the use range of individual account,improving the level of medical insurance pooling,and exploring outpatient pooling to promote the sustainable development of the basic medical insurance system for urban employees.