| 引用本文：王延中, 赵东辉.新制度主义视角下城乡居民大病保险保障效果的影响因素分析[J].中国卫生政策研究,2021,14(11):1-8 |
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| 新制度主义视角下城乡居民大病保险保障效果的影响因素分析 |
| 投稿时间：2021-10-13 修订日期：2021-11-17 PDF全文浏览 HTML全文浏览 |
| 王延中1, 赵东辉2,3 |
1. 中国社会科学院民族学与人类学研究所 北京 100081;
2. 中国人民大学劳动人事学院 北京 100872;
3. 国家卫生健康委卫生发展研究中心 北京 100044 |
| 摘要:新制度主义认为，制度因素是影响参与者的行为选择，并进而导致不同结果的重要变量。基于这一视角，当前城乡居民大病保险制度的保障效果不尽理想，首先应当从其制度框架方面寻找原因和影响因素。大病保险制度缺乏清晰明确的制度定位导致了一定的执行偏差，对关键概念的化用不利于充足保障和精准保障目标的实现，“类保险化”的补偿政策限制了大病保险的作用空间，筹资机制难以满足保障需要则直接导致了补偿不足。基于制度框架的不足，要更好解决城乡居民的大病保障问题，需要对当前的城乡居民大病保险制度进行根本性重构。在近期，基于不同人群的保障需求，建立起包括基本医保、医疗救助和补充医疗保险等多种保障形式的综合性的大病保障制度体系。在中长期，当基本医保对大额医疗费用的实际补偿水平达到70%以上时，在基本医保制度中建立个人自付费用封顶机制，从根本上解决大病保障问题。 |
| 关键词:新制度主义 城乡居民大病保险 保障效果 影响因素 |
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| Analysis on the influencing factors of the guarantee efficacy of critical illness insurance for urban and rural residents from the perspective of new institutionalism |
| WANG Yan-zhong1, ZHAO Dong-hui2,3 |
1. Institute of Ethnology and Anthropology, Chinese Academy of Social Sciences, Beijing 100081, China;
2. School of Labor and Human Resources, Renmin University of China, Beijing 100872, China;
3. China National Health Development Research Center, Beijing 100044, China |
| Abstract:New Institutionalism believes that institutional factors are important variables that could influence the behavioral choices of participants and thereby induce different results. From this perspective, the current guarantee efficacy of critical illness insurance for urban and rural residents should be judged as suboptimal. To solve this problem, the first step should be to look for the underlying reasons and influencing factors in the institutional framework. The current critical illness insurance policy lacks clear system positioning, which has led to deviations during previous policy implementation. The misuse of key concepts hinders the achievement of the goal of accurate and adequate medical guarantee. The "quasi-insurance" reimbursement policy limits the working space of critical illness insurance, whereas the financing mechanism being unable to meet the needs of medical guarantee directly results in deficiency in reimbursement. Due to the defects in the institutional framework, to better solve the low guarantee efficacy problem in critical illness insurance for urban and rural residents requires fundamental reconstruction of the current critical illness insurance system. In the short term, a comprehensive medical guarantee system for critical illness should be established based on the needs of different population groups, covering basic medical insurance, medical assistance and supplementary medical insurance. In the medium and long term, once the actual reimbursement level of basic medical insurance reaches 70% or even higher, a capping mechanism for individual out-of-pocket payment should be introduced into the basic medical insurance program, so as to essentially solve the guarantee efficacy problem in critical illness. |
| Key words:New institutionalism Critical illness insurance for urban and rural residents Guarantee efficacy Influencing factors |
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