防返贫视域下我国大病保险政策评价与优化研究

王微; 张倩

doi:10.19546/j.issn.1674-3830.2023.2.011

中国医疗保险 ›› 2023, Vol. 0 ›› Issue (2) : 69-82. DOI: 10.19546/j.issn.1674-3830.2023.2.011

观察思考

防返贫视域下我国大病保险政策评价与优化研究

王微, 张倩

作者信息 +

Research on Policy Evaluation and Optimization of Critical Illness Insurance System in China from the Perspective of Anti-poverty

Author information +

文章历史 +

摘要

以防返贫视域评价大病保险政策,分析政策要素与制度运行效果间的关系,识别政策偏差与制度不足,并提出优化策略,对新时期完善大病保险政策体系、提升防返贫治理效能具有重要的理论和实践意义。基于政策一致性指数模型（PMC）和质性比较分析方法（QCA）,以28项省级大病保险政策文本为分析对象,定量评价大病保险政策的总体特征与不足,并定性比较多种政策要素与大病保险制度运行效果之间的关系,探寻优化大病保险制度的政策要素。研究表明：省级大病保险政策的PMC得分均值为6.922分,政策制定总体尚可,也存在风险预判能力不足、兜底保障作用不够、重特大疾病保障力度有限、商业保险机构未充分发挥专业优势等问题。大病保险运行效果受多重政策因素影响,为使大病保险制度取得较好的防返贫效果,未来需增强政策内容的预测性、增强制度的兜底保障作用、提高保障效能、提高与其他保障政策的耦合度、优化社商合作机制等。

Abstract

It is of great theoretical and practical significance for improving the critical illness insurance policy system and the efficiency of anti-poverty governance in the new era to evaluate the critical illness insurance policy from the perspective of anti-poverty, analyze the relationship between the policy elements and the effect of the system, identify the policy deviation and institutional deficiencies, and propose optimization strategies. Based on the PMC index model and Qualitative Comparative Analysis (QCA), the paper takes 28 provincial critical illness insurance policy texts as the analysis objects, quantitatively evaluates the overall characteristics and deficiencies of the critical illness insurance policy, qualitatively compares the relationship between various policy elements and the effect of the critical illness insurance system, and explores the policy elements for optimizing the critical illness insurance system. The research shows that the average PMC score of the provincial critical illness insurance policy is 6.922, and the policy formulation is generally fair, but there are also problems such as insufficient risk pre-judgment ability, insufficient guarantee of basic living standard, limited support for major and serious diseases, and commercial insurance institutions not fully playing professional advantages. The operation of the critical illness insurance is affected by multiple policy factors. In order to make the critical illness insurance system achieve better anti-poverty effect, it is necessary to enhance the predictability of the policy content as well as the role of the system as a basic guarantee, improve the security efficiency, improve the coupling degree with other security policies, and optimize the cooperative mechanism of social and commercial insurance in the future.

导出引用

王微, 张倩. 防返贫视域下我国大病保险政策评价与优化研究[J]. 中国医疗保险. 2023, 0(2): 69-82 https://doi.org/10.19546/j.issn.1674-3830.2023.2.011

Research on Policy Evaluation and Optimization of Critical Illness Insurance System in China from the Perspective of Anti-poverty[J]. China Health Insurance. 2023, 0(2): 69-82 https://doi.org/10.19546/j.issn.1674-3830.2023.2.011

中图分类号： F840.684 C913.7

参考文献

[1] 朱铭来,谢明明,完善我国重特大疾病医疗保障机制的思考[J] ,中国医疗保险,2022(1).
[2] 陈中南,孙圣民.大病保险的减贫效果研究——基于CFPS数据的实证分析[J].暨南学报(哲学社会科学版),2022,44(03):24-39.
[3] 罗浩,周延.城乡居民大病保险减贫效应研究[J].海南大学学报(人文社会科学版):1-11[2022-06-23].
[4] 高健,丁静.新农合大病保险能缓解农村长期贫困吗?——来自贫困脆弱性视角的检验[J].兰州学刊,2021(04):170-181.
[5] 许新鹏,顾海.大病保险对中老年居民医疗利用及健康的影响——基于CHARLS数据的实证检验[J].人口与发展,2022,28(01):16-29.
[6] 黄家林,傅虹桥.补充医疗保险对老年人死亡率的影响:以大病保险为例[J].世界经济,2021,44(10):179-200.
[7] 李亚青,罗耀.大病保险是否改善了医疗弱势群体的保障状况——以老年人和低收入群体为例[J].广东财经大学学报,2020,35(06):100-110.
[8] 唐兴霖,黄运林,李文军.地方政府城乡居民大病保险政策比较及其优化研究[J].理论探讨,2017(06):151-156.
[9] 戴伟. 政策精准治理视角下我国大病保险定位与发展研究——基于四省大病保险试点运行数据的分析[J].社会保障研究,2019(05):42-51.
[10] 田文华. 基于RE-AIM模型的城乡居民大病保险模式评估[J].复旦学报(社会科学版),2021,63(01):152-160.
[11] 刘洋. 城乡居民大病保险问题与对策研究——以陕西省为例[J].西安交通大学学报(社会科学版),2016,36(06):75-78.
[12] 王奕婷,王运柏.完善城乡居民大病保险制度的思考——以湖南省为例[J].中国医疗保险,2022(04):63-68.
[13] 王黔京.城乡居民大病保险受益群体与分配效应研究——基于贵州省的实地调查数据[J].现代预防医学,2021,48(22):4117-4120+4157.
[14] 魏哲铭,贺伟.城乡居民大病保险制度实施困境与对策——以西安市为例[J].西北大学学报(哲学社会科学版),2017,47(04):107-113.
[15] 朱斌,张宁,何荣鑫.重特大疾病保障政策的实践与效果——基于延安市的实证研究[J]. 卫生经济研究,2022.39(2):14-18.
[16] 刘亭立,傅秋园.绿色能源产业创新政策的量化评价与优化路径探究[J].中国科技论坛,2018(10):82-92.
[17] 吴升华,钟志刚,冯俊,等.政策工具视角下我国城乡居民大病保险政策的文本量化分析[J].中国卫生经济,2020,39(01):17-21.
[18] 顾海,朱晓文,钱瑛琦.大病保险政策评价指标体系构建与效果评价——以江苏省为例[J] 中国卫生管理研究,2016(01):63-83+98.
[19] 赵鑫. 基于模糊积分法的天津市大病保险政策评价研究[D].天津财经大学,2020.
[20] 赵思琦,刘栋梁,夏毓琦.基于PMC指数模型的我国慢病管理政策量化评价[J].中国药房, 2021.32(13):1627-1633.
[21] 于雪,邓晶,谭华伟,等.基于PMC指数模型的我国健康扶贫政策量化评价研究[J].现代预防医学,2021.48(22):4131-4135.
[22] 张文静,张丽,姚俊.长期护理保险制度政策评价:基于PMC指数模型[J].中国卫生事业管理,2021.38(02):103-108.
[23] 陈嘉歆,吴婷婷,付蔓霞.基于PMC指数模型的我国按疾病诊断相关分组付费政策量化评价[J].中国药房,2022.33(13):1559-1564.
[24] 赵云辉,徐晓敏,李亚慧,等.民族地区大数据技术发展与政府公共卫生治理研究[J].民族研究,2022(1):48-66.
[25] 王永伟,王德军,孔凡玲.疾控人员职业紧张高危风险因素集定性比较研究[J].川北医学院学报,2014.29(1):32-38.
[26] 王晨,吴群红,孙明雷,等.基于定性比较分析方法的薪酬满意度影响因素研究[J].中国医院,2022.29(1):29-31.
[27] ESTRADA M.Policy modeling: definition,classification and Evaluation[J].Journal of Policy Modeling,2011,33(4):523-536.
[28] 王啸宇,张欢.长护险制度设计评价与运行效果研究[J].公共行政评论,2021,14(05): 81-100+198.
[29] 封铁英,南妍.公共危机治理中社会保障应急政策评价与优化——基于PMC指数模型[J].北京理工大学学报(社会科学版),2021,23(05):75-84.
[30] 张文静,张丽,姚俊.长期护理保险制度政策评价:基于PMC指数模型[J].中国卫生事业管理,2021,38(02):103-108.