制度变迁视角下我国基本医疗保险一体化的发展

Development of China’s basic medical insurance integration from the perspective of institutional change

新中国成立不久,我国按照城乡“二元”结构建立了公费医疗、劳保医疗和农村合作医疗制度;改革开放后,我国又逐渐构建起城镇职工基本医疗保险制度、新型农村合作医疗制度和城镇居民基本医疗保险制度。进入21世纪,各地在对三大基本医疗保险制度整合探索中又形成了东莞、苏州、神木等不同模式。2010年全国人大常委会通过的《社会保险法》并没有规定三保合一的目标和实现路径。2016年在全国范围内新型农村合作医疗制度和城镇居民基本医疗保险制度被整合为城乡居民基本医疗保险制度,实现了二保合一。而在全国范围内不区分地域和职业进行基本医疗保险基金的统筹,并实行全民统一的基本医疗保险待遇至今还没有实现。但是,新中国刚成立时中国人均预期寿命不到40周岁,而2000年中国人均预期寿命已经超过70周岁,这一成就的取得与我国城乡居民基本医疗保险制度的确立有密切关系。由此可见,我国城乡居民的基本医疗保险没有按照英、德等国的一体化制度进行设计,而是先区分城乡和职业分别构建了不同的基本医疗保险制度,而后在地方探索的基础上逐渐整合相关制度,认识其合理性和正当性需要从制度变迁视角去进行分析。

Shortly after the founding of new China, China established public medical care, labor insurance medical care and rural cooperative medical care system according to the "dual" structure of urban and rural areas. After the reform and opening up, China has gradually established the basic medical insurance system for urban workers, the new rural cooperative medical system and the basic medical insurance system for urban residents. In the 21 st century, different modes such as Dongguan, Suzhou and Shenmu have been formed in the exploration of the integration of the three basic medical insurance systems. The Social Insurance Law passed by the Standing Committee of the National People’s Congress in 2010 does not stipulate the goal and realization path of the integration of three guarantees. In 2016, the new rural cooperative medical system and the basic medical insurance system for urban residents were integrated into the basic medical insurance system for urban and rural residents nationwide, realizing the integration of two guarantees. However, the overall planning of basic medical insurance fund and the implementation of unified basic medical insurance treatment for the whole people have not been realized so far. However, when new China was founded, China’s per capita life expectancy was less than 40 years old, while in 2000, China’s per capita life expectancy has exceeded 70 years old. This achievement is closely related to the establishment of China’s basic medical insurance system for urban and rural residents. It can be seen that the basic medical insurance for urban and rural residents in China is not designed according to the integrated system of Britain, Germany and other countries, but first distinguishing urban and rural areas and occupations, different basic medical insurance systems are built, and then gradually relevant systems are integrated on the basis of local exploration. To understand its rationality and legitimacy, we need to analyze it from the perspective of institutional change.