医疗救助制度需要解决救助对象识别、救助标准厘定、潜在困难群体保障三大核心问题,需要从制度内部与外部进行完善的路径建构。医疗救助制度内部,探索建立以家庭灾难性卫生支出为基础的因病支出型困难的评定标准;根据分类救助原则,对不同困难人员设置不同的报销梯度以及保障范围,以完善医疗救助待遇标准。医疗救助制度外部,按照“先保险、后救助”的原则有序衔接基本医保、大病保险和医疗救助,形成贯序减负机制,通过信息系统一体化和责任主体相对统一,提升管理效率;畅通社会救助体系的家庭经济状况核对数据共享,建立因病致贫预警机制以及预警结果处置机制;通过项目化或产品化的慈善帮扶或商业健康险建立政策范围外医疗费用减负机制。

The medical assistance system needs to address three core issues, i.e. the identification of assistance recipients, the determination of assistance standards, and the security of potential disadvantaged groups. The improvement of the system requires a path from both internal and external perspectives. Internally, it is essential to establish the criteria for evaluating poverty caused by illness based on catastrophic health expenditure at the household level. According to the principle of categorized assistance, different reimbursement gradients and applicable coverage should be set for various disadvantaged groups to improve the standards of medical assistance benefits. Externally, following the principle of "insurance first, followed by assistance", a well-ordered connection between basic medical insurance, major illness insurance, and medical assistance is established to form a sequential relief mechanism. This is achieved through the integration of information systems and a relatively unified responsible parties to improve the management efficiency. The establishment of a data-sharing mechanism for verifying the economic status of households within the social assistance system is crucial. Also we should create an early warning mechanism for poverty due to illness and a corresponding mechanism for handling warning results. Additionally, a relief mechanism for medical expenses beyond the policy should be established through project-based or product-based charitable assistance or commercial health insurance.