| 引用本文：高健, 徐英奇, 李华.德国经验对中国社会医疗保险省级统筹设计的启示[J].中国卫生政策研究,2019,12(6):29-34 |
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| 德国经验对中国社会医疗保险省级统筹设计的启示 |
| 投稿时间：2018-11-02 修订日期：2019-03-15 PDF全文浏览 HTML全文浏览 |
| 高健, 徐英奇, 李华 |
| 上海财经大学公共经济与管理学院 上海 200433 |
| 摘要:本文以中国城镇职工基本医疗保险为对象，研究省级统筹模式的设计。首先，介绍中国统筹层次提升的现实背景，以及调剂金模式、统收统支两大模式运行的特点和存在的问题。其次，详细介绍德国在统筹层次提升历程中所采用的风险结构补偿机制（RSA）、基于发病率的风险结构补偿机制（morbi-RSA）、中央健康基金机制（CHF）。最后，基于中国现有的经办水平和政府间责任划分实情，提出"考虑疾病风险的调剂金式的省级统筹"或"统收统支式的省级统筹+基于风险调整的资金分配机制"两套省级统筹方案，以及中国省级统筹改革的现实路径。 |
| 关键词:社会医疗保险 风险调剂 统收统支 责任划分 |
| 基金项目:国家社会科学基金项目"城乡居民大病保险精准治理健康贫困的效果研究"（18BGL240） |
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| Implications of German experience on provincial comprehensive design of social medical insurance in China |
| GAO Jian, XU Ying-qi, LI Hua |
| School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai 200433, China |
| Abstract:This paper aims at studying the design of a mechanism to improve the health insurance risk pooling in China taking employee health insurance as an example for a comprehensive design at provincial level. Firstly, it introduces the real background of targeted improvement based on the existing improvements in health insurance design at all levels in China, the existing risks, as well as the characteristics and existing problems of the two modes of risk-adjustment and unified collection and allocation system. Secondly, it introduces Risk Structure Adjustment (RSA) mechanism adopted by Germany in the process of overall design improvement, morbidity-based risk structure adjustment (morbi-RSA) mechanism, and the central health fund (CHF) system. Finally, based on the current situation of China's current management status and responsibility allocation, and drawing on the experience from Germany, China can use "morbidity-based risk adjustment mode" or "morbidity-based overall planning mode", and a realistic routine to achieve provincial-level in a two-set system of provincial-level overall plans and realistic path of overall reform. |
| Key words:Social health insurance Risk adjustment Unified collection and allocation Responsibility allocation |
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