我国多层次医疗保障体系的层次定位存在部分模糊性,一定程度上影响了制度体系保障效能的提升。从层次性视角出发,本研究构建健康“需要–需求–保障”理论逻辑：公众多层次的健康需要结合支付能力转化为差异性的健康需求,进而内生出多元制度力量实现健康保障。结合国际经验对我国多层次医疗保障制度适配安排展开分析,在“基本公平基础上的效率增益”价值导向下,基本制度三重保障适配基本医疗需求,争取实现从充分保基本到个人自付封顶目标,但短期内需要同样适配基本医疗需求的惠民保、职工互助保障以及慈善医疗救助提供重特大疾病保障助力;基础型、中端型、高端型商业医疗保险分别适配预防与康复、舒适就医、健康自我实现等多元健康需求,商业疾病保险则通过满足财务安全需求间接助力健康保障,实现更加全面的“医有所保”。基于此,本研究提出分层适配价值导向下的政策优化、技术构建3+N层次协同治理机制、围绕健康需求细化层次供给行动等建议和思考。
Abstract
There is certain ambiguity in the hierarchical positioning of China's multi-level healthcare security system. This ambiguity, to a certain degree, hinders the enhancement of the system's guarantee efficiency. From a hierarchical perspective, this research constructs a theoretical framework of health "needs-demands- security". That is, the public's diverse health needs at different levels, when combined with their respective payment capabilities, are translated into differentiated health demands. These demands then drive multiple institutional forces to materialize health security. Drawing on international experience, this study delves into the adaptive arrangements of China's multi-level healthcare security system. Guided by the value orientation of "attaining efficiency while ensuring basic fairness", the triple-guarantee mechanism of the basic system is tailored to meet the basic medical needs. The aim is to fully safeguard the fundamentals and set a ceiling on personal out-of-pocket expenses. However, in the short term, it is imperative that programs such as city-customized commercial health insurance, employee mutual-aid security, and charitable medical assistance adapt to meet basic medical demands, thereby strengthening the support system for catastrophic diseases. Meanwhile, basic, mid-level, and high-end commercial medical insurances are respectively designed to address a wide range of health demands, including prevention and rehabilitation, comfortable medical services, and the self-actualization of health. Additionally, commercial disease insurance contributes to health security indirectly by fulfilling the financial security requirements, thereby working towards the goal of achieving more comprehensive "universal medical security". Based on these findings, this study puts forward several suggestions and considerations, including optimizing policies under the value orientation of hierarchical adaptation, establishing a 3 + N hierarchical collaborative governance mechanism, and refining hierarchical supply measures in line with health demands.
关键词
多层次医疗保障体系 /
健康需求 /
商业健康保险 /
分层适配
Key words
multi-level healthcare security system /
health needs /
commercial health insurance /
hierarchical adaptation
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基金
中国人民大学公共管理学院跨学科创新团队项目“我国老年失能照护体系优化研究：需求、筹资与服务”
