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社会医疗保险是保证社会成员公平享有基本医疗服务,促进全民健康水平提高的重要工具,但部分微观制度设计的不当,造成社会医疗保险在收入再分配上呈现从低收入者向高收入者转移的“逆向转移”情况,是一种效率和公平的双损失。文章从微观制度设计角度分析我国社会医疗保险出现收入再分配“逆向转移”现象的原因,提出通过在医疗保险费用征收和医疗保险待遇给付两个环节对相应微观制度设计进行调整,并结合其他国家经验,提出扭转这种收入再分配上的“逆向转移”现象的建议。
Social medical insurance is an important tool to ensure that members of the society enjoy basic medical services in an equitable way and promote the improvement of people’s health level. However, due to the improper design of some micro-systems, social health insurance has shifted the distribution of social health insurance from low-income earners to high-earning earners “Reverse transfer ” situation, is a double loss of efficiency and fairness. The article analyzes the reason of the phenomenon of “redistribution of income” in China’s social medical insurance from the perspective of micro-institutional design, and proposes to adjust the corresponding micro-institutional design through the two aspects of the medical insurance premium collection and medical insurance benefits payment The experience of other countries has put forward proposals to reverse this “redirection” of income redistribution.