制度变迁中农村社会医疗保险的财务保护效果研究

Research on Financial Protection Effect of Rural Social Medical Insurance in the Process of Institutional Change

目的:了解制度变迁中我国农村社会医疗保险的财务保护改善情况,为推动医疗保障高质量发展提供参考。方法:利用中国家庭追踪调查的2012年、2014年、2016年、2018年数据,通过测算灾难性医疗支出发生率和避免医疗财务风险的卫生资金缺口评估农村社会医疗保险的财务保护改善情况。结果:2012-2018年,灾难性医疗支出发生率未发生明显下降,按方法1计算,4个年度的灾难性医疗支出发生率依次为18.78%、17.34%、18.03%和15.43%,按方法3计算,依次为33.33%、38.23%、28.90%和32.09%。避免医疗财务风险的卫生资金缺口却逐年增大,样本户均缺口由4900元增加到7192元。结论:农村社会医疗保险的财务保护能力并未在制度变迁中获得明显改善,而且改善财务保护能力的难度越来越大。应持续强化社会医疗保险的再分配功能,不断完善医疗保障的控费机制,进一步推进医疗保障制度之间的协同。

Objective:To understand the improvement of financial protection capacity of China's rural social medical insurance in the process of institutional changes,so as to provide references for promoting high-quality development of healthcare security.Methods:According to the data collected by the China family panel studies in 2012,2014,2016 and 2018,this paper evaluated the improvement of financial protection capacity of China's rural social medical insurance by means of calculating the incidence of catastrophic health spending and the funding gap to avoid health financial risk.Results:From 2012 to 2018,the incidence of catastrophic health spending had not decreased significantly.The incidence rates of catastrophic health spending in the four years were 18.78%,17.34%,18.03%and 15.43%,respectively based on the method 1,and 33.33%,38.23%,28.90%and 32.09%,respectively based on the method 3.The funding gap to avoid health financial risk had increased year by year.The gap of household average had increased from 4900 yuan to 7192 yuan.Conclusion:The financial protection capacity of rural social medical insurance has not been significantly improved during institutional changes,and it is increasingly difficult to improve the financial protection capacity.It is necessary to continuously strengthen the function of redistribution of social medical insurance,keep on improving the cost control mechanism of healthcare security,and further advance the coordination of healthcare security systems.