完善吉林省城镇居民社会医疗保障制度的对策研究
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摘要
随着医疗体制改革的大幕拉开,医疗保障体系建设将得到不断的改进。而医疗保障体系的深入改革将影响到全国十几亿人口的看病待遇问题,涉及千家万户,是为百姓谋福祉的伟大事业,是任何政府都较为关注和亟待解决的大问题。为此,我们将对医保体系中最为关系民生的城镇居民医保进行探索和研究,结合对吉林省城镇居民医保建设的评估,总结情况,发现问题,探索途径,结合目前从事的医保工作,对城镇医保进行总结和概括,并进行深入调研,为吉林省医保城镇居民医保事业的发展和完善,提供一些参考。发现一些医疗保障体制欠完善、制度不健全方面。社会医疗保险制度是关切民众健康的重要工程,作为社会保障制度的一个重要组成部分,不仅是一场深刻的社会变革,同时也是一项世界性难题,其制度设计关系到千家万户的切身利益,是关系到国计民生的大事。因此,在社会保障制度改革的推进过程中,社会医疗制度的改革和发展尤其受到社会各界的广泛关注。如何进行合理的制度设计,应对医疗保险中所面临的道德风险和逆向选择等特殊症结,解决医疗费用过高以及制度实施过程中公平欠缺、效率低下等问题,推动医疗保险平稳持续发展,确保社会公众的健康状况不断改善,成为当今社会必须应对的时代课题。
近年来,社会医疗保障制度一直是各方广泛关注的热点,特别是2009年备受关注的《中共中央国务院关于深化医药卫生体制改革的意见》正式出台。明确了未来三年的阶段性工作目标,增加了诸如增加财政投入、实现全面医保等举措更是令人瞩目。众多学者都非常关注中国整体社会医疗保障的研究,通过详细的理论研究,提出中国社会医疗保险制度改革的总体发展思路。然而针对吉林省城镇居民社会医疗保障制度的专题研究还不多见。本文侧重于深入研究吉林省城镇居民社会医疗保险制度的相关发展历程、现实状况及其中存在的问题,对比我国其他地方城镇医疗保障的发展模式,试图对吉林省城镇居民医疗保障制度提出有价值的、具有建设型的对策建议。
Jilin Province is a famous old industrial bases, which is one of the country's major agricultural province, a company laid off, unemployed and migrant workers of rural dwellers have occupied a large proportion of impoverished by hospitalization, and the illness into poverty once again from time to occurred. The basic medical insurance system for urban residents in the implementation of the masses will no doubt solve the province's basic medical security issues have a significant impact, but also for the whole of Jilin Province's economic development and social progress, enormous protection. But in terms of its system itself is in Jilin province is still a fresh thing for the urban residents in the social security system of health insurance mandate has not yet completed, Need to constantly review and exploration in order to gradually increase the level of medical care of residents in order to constantly in the twists and turns toward a sound and improved.
Article summarizes the use of literature, empirical and comparative research methods and many other urban residents in Jilin province carried out the basic medical insurance system for theoretical exploration and practical research. The article is divided into five parts: First, this research background and significance, content and methods, and lack of innovation points and a brief statement; Secondly, from the medical insurance system for urban residents, the concept of starting, in the review of basic medical care for urban residents insurance system, establishment and development of the historical evolution, while the role of the establishment of the system conducted in-depth analysis; third, For urban residents in Jilin Province to establish the basic medical insurance system, the premise of the analysis of socio-economic status, through the system operational status in Jilin Province, the evaluation of the analytical and empirical study on the problems in their development to explore; Fourth, other countries in the international medical insurance system assessment, and for our province from the example of some of the basic medical insurance system for urban residents in the development of advanced experiences; fifth, by proposing to expand the scope of benefits, strengthen advocacy efforts to improve co-ordination level, adjust the subsidy policy, improve the incentive mechanism to accelerate the development of community health services to strengthen the handling machine Structure of capacity-building and other related policy recommendations to continuously improve and develop the basic medical insurance system for urban residents so that residents can receive more than the benefits, in order to achieve institutional design in mind.
近年来,社会医疗保障制度一直是各方广泛关注的热点,特别是2009年备受关注的《中共中央国务院关于深化医药卫生体制改革的意见》正式出台。明确了未来三年的阶段性工作目标,增加了诸如增加财政投入、实现全面医保等举措更是令人瞩目。众多学者都非常关注中国整体社会医疗保障的研究,通过详细的理论研究,提出中国社会医疗保险制度改革的总体发展思路。然而针对吉林省城镇居民社会医疗保障制度的专题研究还不多见。本文侧重于深入研究吉林省城镇居民社会医疗保险制度的相关发展历程、现实状况及其中存在的问题,对比我国其他地方城镇医疗保障的发展模式,试图对吉林省城镇居民医疗保障制度提出有价值的、具有建设型的对策建议。
Jilin Province is a famous old industrial bases, which is one of the country's major agricultural province, a company laid off, unemployed and migrant workers of rural dwellers have occupied a large proportion of impoverished by hospitalization, and the illness into poverty once again from time to occurred. The basic medical insurance system for urban residents in the implementation of the masses will no doubt solve the province's basic medical security issues have a significant impact, but also for the whole of Jilin Province's economic development and social progress, enormous protection. But in terms of its system itself is in Jilin province is still a fresh thing for the urban residents in the social security system of health insurance mandate has not yet completed, Need to constantly review and exploration in order to gradually increase the level of medical care of residents in order to constantly in the twists and turns toward a sound and improved.
Article summarizes the use of literature, empirical and comparative research methods and many other urban residents in Jilin province carried out the basic medical insurance system for theoretical exploration and practical research. The article is divided into five parts: First, this research background and significance, content and methods, and lack of innovation points and a brief statement; Secondly, from the medical insurance system for urban residents, the concept of starting, in the review of basic medical care for urban residents insurance system, establishment and development of the historical evolution, while the role of the establishment of the system conducted in-depth analysis; third, For urban residents in Jilin Province to establish the basic medical insurance system, the premise of the analysis of socio-economic status, through the system operational status in Jilin Province, the evaluation of the analytical and empirical study on the problems in their development to explore; Fourth, other countries in the international medical insurance system assessment, and for our province from the example of some of the basic medical insurance system for urban residents in the development of advanced experiences; fifth, by proposing to expand the scope of benefits, strengthen advocacy efforts to improve co-ordination level, adjust the subsidy policy, improve the incentive mechanism to accelerate the development of community health services to strengthen the handling machine Structure of capacity-building and other related policy recommendations to continuously improve and develop the basic medical insurance system for urban residents so that residents can receive more than the benefits, in order to achieve institutional design in mind.
引文
1仇雨临：医疗保险[M],中国劳动社会保障出版社2008年版,第2页。
任正臣：社会保险学[M],社会科学文献出版社2001年版,27-28。
3仇雨临,孙树菌：医疗保险[M],中国人民大学出版社2001年版,第6-7页。
4郑功成：社会保障学——理念、制度、实践与思辨[M],商务印书馆2000年版,第445页。
5劳动和社会保障部医疗保险司：中国医疗保险制度改革政策与管理[M],中国劳动社会保障出版社1999年版,第260页。
6刘敏：我国城镇医疗保险制度改革问题与对策研究[D],武汉科技大学硕士论文,2007年。
7数据参见王云山岫等：吉林省发展报告[M],吉林人民出版社 2008年版。
8陈幼芳、李娟、邹宇昆、王彦：职工医疗保障制度改革难点问题探讨[J],东岳论丛2000.3。
[1]Arrow K. J. Uncertainty and the welfare economics Of medical care. American Economic Review,1963, VOl. 53:941-973
[2]Evens R.G. Supplier-induced demand:some empirical evidence and implications. The economics Of Health and Medical Care,1974.
[3]Grossman M. The demand for health:A theoretical and empirical investigation. New York: Columbia University Press,1972.
[4]Acton J. P Non-monetary factors in the demand for medical services:some empirical evidence. Journal Of Political Economy,1975, VOl.83.
[5]Newhouse J. P Medical-care expenditure:a cross-national survey. Journal Of Human Resource,1977, VOl. 12.
[6]Kalian E. The determinants Of national outlay On health. The Economics Of Health and Medical Care,1974.
[7]Saenz M., Murillo C. Shared features in prices:income and price elastic ties for health care expenditures. Health Economics,1994, VOl. 3.
[8]锁凌燕,《转型期中国医疗保险体系中的政府与市场—基于城镇经验的分析框架》.北京大学出版社,2010.
[9]郑功成,《中国社会保障30年》.北京,人民出版社,2008.
[10]楚敏伟,《我国社会保障的和谐发展之路》.北京,中国财经经济出版社,2008.
[11]盖锐、杨光,《社会保障学》.清华大学出版社.2009.
[12]邵汉生,《政府引导制度覆盖——完善城镇居民医疗保障体系的思考》.中国社会保障,2006(11)
[13]国务院关于开展城镇居民基本医疗保险试点的指导意见(国发(2007)20号).2007-7-10.
[14]孙文基,蒋大鸣：《城镇居民基本医疗保险制度及其监督机制研究》.审计与经济研究,2008(7).
[15]施金美,唐颖、邹杰：《建立城镇居民基本医疗保险制度的实践与思考》.中国初级卫生保健,2008(2)
[16]刘洪清,《思路决定出路——城镇居民医保试点透视》.中国社会保障,2006(11).
[17]蔡跃进、高亚男,《居民医保：从试点走向完善》.中国劳动,2008(7).
[18]王振平、王金营、宋风轩、张晶、阎宇虹,《我国城镇居民基本医疗保险制度初探》.中国卫生事业管理,2007(10).
[19]王小章,《中国发达地区社会保障—来自浙江的报告》.浙江大学出版社,2007(11).
[20]严良军,《城镇居民医疗保险的行与思》.中国社会保障,2006(9).
[21]王志勇,《如何做好城镇居民基本医疗保险试点工作》.财政监督,2008(6)
[22]曹继安,《城镇居民基本医疗保险制度建设的问题和对策》.西部财会,2008(5).
[23]孙文基,《建立和完善城镇居民基本医疗保险制度的基本思路》.中国卫生事业管理,2008(7).
[24]陈德贤,《关于城镇居民基本医疗保险若干问题的思考》.中国医疗保险,2009(2).
[25]吴丰芹,《对城镇居民医疗保险工作的思考》.山东劳动保障,2008(7).
[26]王樱,《城镇居民基本医疗保险就医路径的探索》,江苏卫生事业管理,2008(1).
[27]刘晓敏、王雪冬,《构建城乡一体化社会医疗保险制度的瓶颈和思路》.中国医疗保险,2009(2).
[28]付晓光、汪早立、张西凡、程念,《新农合与城镇居民医疗保险制度相衔接问题的讨论》,中国农村卫生事业管理,2008(3).
[29]《中共中央国务院关于深化医药卫生体制改革的意见》.中央政府门户网站,2009-4-6.
[30]乌日图.《医疗保障制度国际比较》.化学工业出版社.2003.
[31]许正中.《社会医疗保险：制度选择与管理模式》.社会科学文献出版社.2002.
[32]陈佳贵,王延中：中国社会保障发展报告(2007)[M].社会科学文献出版社,2007-5.
[33]邵萍萍,《关于全民医保的思考》.就业与保障,2007(8).
[34]郑功成,《中国社会保障改革与发展战略》.人民出版社.2008(10).
[35]顾昕,《走向全民医保——中国新医改的战略与战术》.北京,中国劳动社会保障出版社,2008.
[36]2006-2009年国家统计公报,国家统计局：http://www.stats.gov.cn/
[37]2006-2009年社会保障公报,国家统计局：http://www.stats.gov.cn/
[38]第五次全国人口普查报告[R].国家统计局：http://www.stats.gov.cn/
[39]吉林省统计局.2009年吉林省国民经济和社会发展统计公报[EB].http://tjj.j1.gov.cn/tjgb/ndgb/201003/t20100301_690512.html
[40]中华人民共和国国家统计局.中华人民共和国2009年国民经济和社会发展统计公报[EB].http://www.stats.gov.cn/tjgb/ndtjgb/qgndtjgb/t20100225_402622945.htm
任正臣：社会保险学[M],社会科学文献出版社2001年版,27-28。
3仇雨临,孙树菌：医疗保险[M],中国人民大学出版社2001年版,第6-7页。
4郑功成：社会保障学——理念、制度、实践与思辨[M],商务印书馆2000年版,第445页。
5劳动和社会保障部医疗保险司：中国医疗保险制度改革政策与管理[M],中国劳动社会保障出版社1999年版,第260页。
6刘敏：我国城镇医疗保险制度改革问题与对策研究[D],武汉科技大学硕士论文,2007年。
7数据参见王云山岫等：吉林省发展报告[M],吉林人民出版社 2008年版。
8陈幼芳、李娟、邹宇昆、王彦：职工医疗保障制度改革难点问题探讨[J],东岳论丛2000.3。
[1]Arrow K. J. Uncertainty and the welfare economics Of medical care. American Economic Review,1963, VOl. 53:941-973
[2]Evens R.G. Supplier-induced demand:some empirical evidence and implications. The economics Of Health and Medical Care,1974.
[3]Grossman M. The demand for health:A theoretical and empirical investigation. New York: Columbia University Press,1972.
[4]Acton J. P Non-monetary factors in the demand for medical services:some empirical evidence. Journal Of Political Economy,1975, VOl.83.
[5]Newhouse J. P Medical-care expenditure:a cross-national survey. Journal Of Human Resource,1977, VOl. 12.
[6]Kalian E. The determinants Of national outlay On health. The Economics Of Health and Medical Care,1974.
[7]Saenz M., Murillo C. Shared features in prices:income and price elastic ties for health care expenditures. Health Economics,1994, VOl. 3.
[8]锁凌燕,《转型期中国医疗保险体系中的政府与市场—基于城镇经验的分析框架》.北京大学出版社,2010.
[9]郑功成,《中国社会保障30年》.北京,人民出版社,2008.
[10]楚敏伟,《我国社会保障的和谐发展之路》.北京,中国财经经济出版社,2008.
[11]盖锐、杨光,《社会保障学》.清华大学出版社.2009.
[12]邵汉生,《政府引导制度覆盖——完善城镇居民医疗保障体系的思考》.中国社会保障,2006(11)
[13]国务院关于开展城镇居民基本医疗保险试点的指导意见(国发(2007)20号).2007-7-10.
[14]孙文基,蒋大鸣：《城镇居民基本医疗保险制度及其监督机制研究》.审计与经济研究,2008(7).
[15]施金美,唐颖、邹杰：《建立城镇居民基本医疗保险制度的实践与思考》.中国初级卫生保健,2008(2)
[16]刘洪清,《思路决定出路——城镇居民医保试点透视》.中国社会保障,2006(11).
[17]蔡跃进、高亚男,《居民医保：从试点走向完善》.中国劳动,2008(7).
[18]王振平、王金营、宋风轩、张晶、阎宇虹,《我国城镇居民基本医疗保险制度初探》.中国卫生事业管理,2007(10).
[19]王小章,《中国发达地区社会保障—来自浙江的报告》.浙江大学出版社,2007(11).
[20]严良军,《城镇居民医疗保险的行与思》.中国社会保障,2006(9).
[21]王志勇,《如何做好城镇居民基本医疗保险试点工作》.财政监督,2008(6)
[22]曹继安,《城镇居民基本医疗保险制度建设的问题和对策》.西部财会,2008(5).
[23]孙文基,《建立和完善城镇居民基本医疗保险制度的基本思路》.中国卫生事业管理,2008(7).
[24]陈德贤,《关于城镇居民基本医疗保险若干问题的思考》.中国医疗保险,2009(2).
[25]吴丰芹,《对城镇居民医疗保险工作的思考》.山东劳动保障,2008(7).
[26]王樱,《城镇居民基本医疗保险就医路径的探索》,江苏卫生事业管理,2008(1).
[27]刘晓敏、王雪冬,《构建城乡一体化社会医疗保险制度的瓶颈和思路》.中国医疗保险,2009(2).
[28]付晓光、汪早立、张西凡、程念,《新农合与城镇居民医疗保险制度相衔接问题的讨论》,中国农村卫生事业管理,2008(3).
[29]《中共中央国务院关于深化医药卫生体制改革的意见》.中央政府门户网站,2009-4-6.
[30]乌日图.《医疗保障制度国际比较》.化学工业出版社.2003.
[31]许正中.《社会医疗保险：制度选择与管理模式》.社会科学文献出版社.2002.
[32]陈佳贵,王延中：中国社会保障发展报告(2007)[M].社会科学文献出版社,2007-5.
[33]邵萍萍,《关于全民医保的思考》.就业与保障,2007(8).
[34]郑功成,《中国社会保障改革与发展战略》.人民出版社.2008(10).
[35]顾昕,《走向全民医保——中国新医改的战略与战术》.北京,中国劳动社会保障出版社,2008.
[36]2006-2009年国家统计公报,国家统计局：http://www.stats.gov.cn/
[37]2006-2009年社会保障公报,国家统计局：http://www.stats.gov.cn/
[38]第五次全国人口普查报告[R].国家统计局：http://www.stats.gov.cn/
[39]吉林省统计局.2009年吉林省国民经济和社会发展统计公报[EB].http://tjj.j1.gov.cn/tjgb/ndgb/201003/t20100301_690512.html
[40]中华人民共和国国家统计局.中华人民共和国2009年国民经济和社会发展统计公报[EB].http://www.stats.gov.cn/tjgb/ndtjgb/qgndtjgb/t20100225_402622945.htm