高质量发展视角下的我国医疗保障制度分析

Analysis of China's Medical Security System from the Perspective of High-quality Development

我国基本医疗保障制度实施以来,发展成效良好,制度框架基本成熟定型,多层次医疗保障制度同步发展,医保与医药、医疗协同发展,筹资公平性得以提升,但在提升运行质量、助力分级诊疗体系建设、发挥二次分配作用等方面仍有提升空间。对此,应推动强制参保,强化基本医疗保险的社会保险属性;合理划分医保筹资中的各方责任,强化个人筹资责任;推动医保基金管理从纵向积累向现收现付转变,提高基金使用效率;加快建立多层次医疗保障筹资机制,提升待遇水平;加强就医管理,促进分级诊疗制度建设;探索以费率为基础的统一基本医疗保险制度,发挥医疗保障制度的二次分配功能。

The China's basic medical security system in has achieved good results.The institutional framework of medical security system is basically mature and finalized,and the multi-level medical security system is developing synchronously.Medical insurance,medicine and medical service have achieved coordinated development,and the fairness in financing has been improved.However,there is still a need to improve operation quality,assist in the construction of a tiered diagnosis and treatment system,and play a role in secondary distribution.In response to the problems,it is necessary to promote compulsory participation and strengthen the social insurance attribute of basic medical insurance,reasonably divide the responsibilities of all parties in medical insurance financing and strengthen individual financing responsibilities,promote the transformation of medical insurance fund management from vertical accumulation to pay-as-you-go and improve the efficiency of fund utilization,accelerate the establishment of a multi-level medical security financing mechanism and improve the level of reimbursement,strengthen medical management and promote the construction of a tiered diagnosis and treatment system,and explore a unified basic medical insurance system based on premium rates and leverage the secondary distribution function of the medical security system.