居民医保个人筹资政策:缘起、困境与优化

Individual Financing Policy of Resident MedicalInsurance:Origin,Dilemma and Optimization

居民医保是中国医保体系的主体性制度安排,而农民构成了居民医保的主要参保群体,该制度优劣直接关乎农民切身利益。中国居民医保采取“财政补助+个人缴费”的筹资模式,在个人缴费标准连年上涨引发居民缴费积极性下降甚至不再参保的情形下,亟待全面分析按人头缴纳等额、定额医保费用的现行居民医保筹资政策及其不良效应,寻求更加合理的政策设计与实践路径。居民医保实践表明,现行的个人筹资机制违背了医保筹资公平原则,导致低收入群体特别是农民群体缴费负担日益加重,加剧了医保逆向调节,还引发了“短板效应”,造成部分群体缴费压力大与总体筹资水平不高并存的矛盾局面。因此,改革现行筹资标准确定办法和年度调整方式势在必行,合理取向应当是综合考虑居民人均可支配收入和经济社会发展水平,实现依据个人或家庭收入一定比例筹资的目标。

The resident medical insurance is a principal institutional arrangement of China’s health insurance system,where thefarmers constitute the main insured group within the system and the quality of the system is directly related to the vital interests of farmers.The health insurance adopts the financing model of“financial subsidies+individual contributions”.In the situation that thepersonal payment standard of the resident medical insurance has been rising for years,which triggers the decline of residents’payment motivation and even the phenomenon of their no longer participating in the insurance,there is an urgent need tocomprehensively review the current resident medical insurance financing policy of paying the fixed or equal amount of medical insurance premiums according to the headcount and its adverse effects,and to seek for a more reasonable policy design and practicepath.The practice of resident medical insurance shows that the current individual financing mechanism violates the equity principleof medical insurance financing,resulting in the increasing payment burden of low-income groups,especially farmers,It has exacerbated the regressive adjustment of the health insurance system,and also leads to the“short board effect”,leading to a paradoxof the coexistence of large payment pressure of some groups and low overall financing level.Therefore,it is imperative to reformthe current financing standard determination method and annual adjustment method,and comprehensively consider the per capitadisposable income of residents and the level of economic and social development,aiming to achieve a financing goal according toacertain proportion ofindividual orfamily income.