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中国的基本医疗保障体系依然存在诸多结构性问题,导致其运行呈现碎片化的状态。城镇职工基本医疗保险长期以来实行退休者免缴费、享待遇的政策。这是城镇职工医保制度建立之初确立的一项规则,后载入了《中华人民共和国社会保险法》,成为一项法定制度。这一制度设计有其合理的历史考量,但现在却难以为继了。因为其对医保筹资的公平性、医保给付的可持续性、医保关系跨地区转移接续等诸多方面造成阻碍,严重影响了整个医保体系运行的公平与效率。
There are still many structural problems in China’s basic medical insurance system, leading to a fragmented state of operation. The basic medical insurance for urban workers has long implemented the policy of retiree exemption from payment and enjoyment. This is a rule set forth at the beginning of the establishment of the urban employee medical insurance system and is enshrined in the Social Insurance Law of the People’s Republic of China and becomes a statutory system. The system design has its reasonable historical consideration, but now it is unsustainable. Because of its equity financing of Medicare, the sustainability of Medicare payment, medical insurance transfer and other areas across the transfer and other obstacles, seriously affecting the operation of the health insurance system, the fairness and efficiency.