| 引用本文：李珍, 王怡欢.论基本医疗保险与商业健康保险的定位与衔接[J].中国卫生政策研究,2020,13(1):9-14 |
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| 论基本医疗保险与商业健康保险的定位与衔接 |
| 投稿时间：2019-12-10 修订日期：2020-01-05 PDF全文浏览 HTML全文浏览 |
| 李珍, 王怡欢 |
| 中国人民大学公共管理学院 中国人民大学健康保障研究中心 北京 100872 |
| 摘要:文章基于学理与实践数据的分析，认为从保障的作用看，基本医保在公平性的投入产出比等方面具有无可替代的作用，基本医保已经且必须继续发挥核心基础作用，商保则应发挥补充保障作用；从保障的内容看，基本医保"保基本"，"保基本"的内涵是保障基本医保目录内的医疗费用，目录应符合临床必需、安全、有效、经济的原则，而高于这些原则的药物、服务及设施就可视为"非基本"，商保应与基本医保互补，保障居民"非基本"的差异化、高层次服务需求，从而实现有效衔接。文章认为新时代背景下，基本医保筹资与需求的缺口，只能通过完善待遇组合模式及城乡居民医保的筹资机制来解决。 |
| 关键词:基本医疗保险 商业健康保险 多层次医疗保障体系 定位与衔接 |
| 基金项目:国家医保局委托重点研究课题:"2050年医疗保障战略目标与‘十四五’重点任务研究"(2019K20256) |
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| Discussion on positioning and connection of basic medical insurance and commercial health insurance |
| LI Zhen, WANG Yi-huan |
| School of Public Administration and Policy, Health Security Research Center, Renmin University of China, Beijing 100872, China |
| Abstract:This paper emphasizes the irreplaceable role that plays the basic medical insurance in the aspect of input-output ratio of fairness based on the theoretical and practical data analysis. The basic medical insurance has been in instrumental action and must continue to play the core basic role, while the commercial insurance should play the supplementary role. From the perspective of the insurance content, the basic medical insurance "guarantees the basic health needs" and the connotation of "basic insurance" is to guarantee the medical expenses in the catalogue of basic medical insurance, which should conform to the principles of clinical necessity, safety, effectiveness and economy. Medicines, services and facilities which are not registered with these principles in the basic medical insurance catalog can be regarded as "non-basic", and thus be excluded from the basic need guarantees to be provided with residents. Commercial insurance and basic medical insurance should complement each other to ensure residents are provided with differentiated and high-level service needs, which can realize effective connection. In this new era, the gap between available funds and the demands of basic medical insurance can only be bridged by improving the treatment combination mode and the financing mechanism of urban-rural medical insurance for residents. |
| Key words:Basic medical insurance Commercial health insurance Multi-level medical insurance system Positioning and connection |
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