脱贫农户医保政策调整影响与发展方向研究

Impact and Development of Healthcare Policy Adjustments for Rural Households Lifted Out of Poverty

适当的医疗保障体系是解决中国农村贫困问题的重要举措,也是预防返贫的重要举措。在脱贫攻坚阶段,医疗救助和医疗保险相结合,通过参保补贴、报销优待和自付部分的再报销等超常措施,解决了因病致贫问题,但在医疗保险基金的可承受性和公平性方面也受到学界和业界的质疑。在巩固拓展脱贫攻坚成果同乡村振兴有效衔接的过渡期,医疗保障政策如何调适是一个复杂的问题,通过政策文本分析与地方实践专题调研,各地在过渡期脱贫户医保政策调整过程中探索出固定型定额补贴、梯次推进型的定额补贴、结合型资助补贴以及基本稳定型等多种调整模式。从政策调整效果和影响来看,救助性质的医保帮扶政策仍很必要,一部分脱贫户的医疗负担仍然较重,欠发达农村仍然需要一定的医疗保障的倾斜支持。面向脱贫人口的医疗保障政策的调整需要在保基本、公平性与可承受性之间找到平衡点。未来政策调整或发展应兼顾基本性、公平性和可承受性原则,梯度推进逐步调整;应优化医疗保障制度结构、弱化政策身份捆绑,统筹解决目录外的大额支出问题;应强化重点帮扶地区医疗保障优惠政策支持,提高重点帮扶地区医疗保障水平;还要通过提升医疗服务效率、挖掘医疗服务潜力,间接提升医保的保障能力。

A suitable healthcare system is crucial for poverty reduction and prevention in rural China.In the previous campaign against absolute poverty,social assistance policy together with social insurance policy has made great contributions to address poverty caused by sickness.Special measures include subsidies for insurance coverage and additional entitlement.However,such extraordinary measures have created debate on the af fordability and fairness of the social insurance fund.In the transition period after the campaign against absolute poverty,the adjustment of the healthcare system is an important but sensitive issue.It is found,through policy text analysis and field survey,that local governments have developed various types of policy adjustments ranging from gradual to radical ones.The study fi nds that the medical burden of some rural households remains heavy.Thus,medical assistance and preferential treatment are still necessary,especially in underdeveloped rural areas.The adjustment of healthcare policies for the poor needs to fi nd a balance between the level of protection,fairness and af fordability.In view of this,future policy adjustments should:(1)follow the principles of providing basic protection,maintain fairness and af fordability,and take gradual steps;(2)optimize the structure of the healthcare system,and systematically reduce high out-of-pocket payment;(3)strengthen the preferential policies in areas that need additional assistance;and(4)enhance the level of protection by improving efficiency and tapping the potential of healthcare services.