整体性治理视域下我国医保体系托底保障功能评估与改进

Evaluation and Improvement of the Supporting Function of China′s Medical Insurance System from the Perspective of Holistic Governance

夯实医保体系托底保障功能是社会政策托底的必然要求,从整体性治理视角对我国当前医保体系托底保障功能进行系统评估十分重要。当前,医保托底保障的制度结构由基本医保、大病保险、医疗救助和补充制度组合而成,托底保障总体成效显著,但面临诸多挑战,制度碎片化使得医保托底的区域不均衡问题突出,制度间功能定位不清影响了医疗救助的核心托底地位,不同制度衔接沟通欠流畅制约了托底效果,单一的费用补偿目标使医保托底更倾向于传统补救模式。我国医保体系托底保障功能改进应坚持整体性治理思路,优化制度组合并强化医疗救助核心地位,优化制度衔接和信息共享,搭建沟通平台进而增强不同主体的治理信任,从补救型托底转向发展型托底并平衡医保托底的区域差异。

Strengthening the basic guarantee function of the medical insurance system is an inevitable requirement of social policy.It is very important to systematically evaluate the basic guarantee function of China′s current medical insurance system from the perspective of holistic governance.At present,the institutional structure of medical insurance support is composed of basic medical insurance,serious illness insurance,medical assistance and supplementary system.The overall effect of support is remarkable,but it faces many challenges.The fragmentation of the system makes the regional imbalance of medical insurance support prominent.The unclear functional positioning between systems affects the core support position of medical assistance.The lack of smooth connection and communication between different systems restricts the bottom-up effect.The single cost compensation target makes the medical insurance more inclined to the traditional remedy model.To improve the support function of China′s medical insurance system,we should adhere to the overall governance idea,optimize the system combination and strengthen the core position of medical assistance,optimize the system connection and information sharing,build a communication platform,so as to enhance the governance trust of different subjects,change from remedial support to developmental support,and balance the regional differences of medical insurance support.