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医疗融资是整个医疗体制的重要组成部分,具有筹集资金、化解风险以及支付费用的功能,其中社会医疗保险是医疗融资的主要渠道。文章从医疗融资方法、融资决策权分配、支付手段及成本控制等方面,比较了改革前后,我国城镇医疗融资体制的发展变化。改革前,政府最终预算融资与全民就业政策,能够保证以就业为基础的“劳保-公费医疗”保险在城镇地区实现全覆盖;改革后,财政分权制、分税制及国有企业改革改变了经济基础,使得同样以就业人口为目标的城镇职工基本医疗保险无法实现全覆盖。扩大现有社会医疗保险基金的风险化解与转移能力,努力推行全体城镇居民基本医疗保险,以及加大财政,特别是中央财政的支持力度是未来医疗融资改革的方向与重点。
Medical financing is an important part of the whole medical system. It has the functions of raising funds, resolving risks and paying fees. Social medical insurance is the main channel of medical financing. The article compares the development and changes of urban medical financing system in our country before and after the reform from the aspects of medical financing method, distribution of financing decision-making power, payment means and cost control. Before the reform, the final budgetary financing by the government and the employment policy of the whole people ensured that employment-based insurance coverage would be fully covered in urban areas. After the reform, the fiscal decentralization, tax-sharing system and state-owned enterprise reform changed The economic base makes it impossible to achieve full coverage of the basic medical insurance for urban workers who also target the working population. Expanding the ability of the existing social medical insurance fund to defuse and transfer risks, pushing forward with the basic medical insurance for all urban residents, and increasing the support for finance, especially the central finance, are the directions and priorities for the reform of medical financing in the future.