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从理论上讲,决定医疗保障水平的指标似乎应该是筹资水平,但事实上,用费用支出指标来衡量医疗保障水平更为可信,因为筹资水平不一定等于费用支付水平,而医疗费用的支出却是医疗保障水平的客观表现。通过对城镇职工医疗保障费用支出及其控制情况的回顾与简要分析,有助于加深我们对医疗保障制度刚性特征的理解。 一、城镇职工医疗保障费用支出情况 (一)国有单位劳保医疗费用支出情况 尽管近10多年来国有单位职工占城镇劳动力总量的比例在不断下降,但迄今仍然占有主体地位。以1978、1985、1990、1997年为例,国有单位职工占城镇从业人员的比例分别为78.32％、70.19％、62.27％、54.65％;如果加上城镇集体单位职工,上述比例分别达到99.84％、96.14％、83.62％、68.92％。因此,国有单位医疗费用的支出事实上代表了中国城镇职工医疗保障费用支出的主体。表1 中国历年国有经济单位医疗卫生费用支出情况简表
In theory, the indicator that determines the level of health care should appear to be the level of funding, but in fact it is more credible to use the cost-expenditure measure to measure the level of health care because the level of funding is not necessarily equal to the level of cost-sharing, It is an objective manifestation of the level of medical security. The review and brief analysis of medical insurance expenses and their control over urban workers can help deepen our understanding of the rigid characteristics of the medical insurance system. I. Expenditure on Medical Security Expenditures for Urban Workers (I) Expenditure on Medical Expenses for State-owned Units Exercising Labor Insurance Although the proportion of state-owned units in the urban labor force has been declining in the recent 10 years, it still occupies the dominant position to date. Taking 1978, 1985, 1990 and 1997 as an example, the proportion of employees in state-owned units in urban areas was 78.32%, 70.19%, 62.27% and 54.65%, respectively. If the urban collective unit workers were added, the above proportions reached 99.84% 96.14%, 83.62%, 68.92%. Therefore, the expenditures of medical expenses of state-owned units actually represent the main body of medical expenses of urban workers in China. Table 1 Summary of Expenditure on Medical and Health Expenditure of State-owned Economic Units in Chinese Historical Places