职工基本医疗保险家庭联保模式的国际经验与启示

基于医疗费用风险从个人溢出至家庭的特点,多数国家都在医疗保障制度中融入家庭联保设计,从而实现以家庭作为分散风险单位的目的。德国实行法定社会医疗保险,“社会国”原则和团结互助共济理念影响德国医疗保险制度走向,家庭成员可随参保缴费者加入医保制度,自动免费享受同等的医疗保险待遇,形成了“家庭共同保险模式”。新加坡实行强制性个人医疗储蓄账户制度,儒家文化深刻影响着新加坡“家庭为根”的价值观,新加坡通过扩展个人医疗储蓄账户的功能和范围,形成了医疗保障的“家庭共享账户模式”。家庭联保是医疗保障制度发展的必然要求,同时也受国家医疗保障制度模式的影响。基于家庭联保国际经验和我国医疗保险制度现状,本文认为我国职工基本医保应在取消个人账户的基础上,以家庭为单位参加医疗保险制度,从而促进制度整合、提升家庭抵御疾病风险的能力。

International experience and enlightenment of family-based joint-insurance in the Basic Medical Insurance System for Urban Employees

Based on the characteristics of medical-cost risk spill over from individual to a family of people, most countries have integrated the family-based joint-insurance into the medical insurance system, so as to achieve the purpose of the family as a decentralized risk unit. Germany has implemented statutory social medical insurance, but the principle of "social state" and the concept of solidarity and mutual assistance do affect the path of medical insurance system in this country. Employees'' family members can automatically get registered for the medical insurance system and enjoy the same medical benefits thereof and free of charge, thus forming the "family common insurance model". In other parts of the world, Singapore, for example, has implemented a compulsory Medisave account system, and the Confucian culture has a profound impact on Singapore''s "family-based" values. By expanding the function and range of Medisave account, Singapore has formed a "family-shared account model" of medical insurance. Accounting for international experience, a family-based joint-insurance is an inevitable requirement for the development of medical insurance system, and it is, in turn, affected by the model of national medical security system. Considering this international experience of family-based joint-insurance and China''s current situation of basic medical insurance system, this paper proves that the family-based joint-insurance constitutes an optimal path, which means China''s basic medical insurance for urban employees should amend the operating system of their individual accounts in terms of insurance benefits. Nonetheless, insured workers'' family members should also be included within the workers'' medical insurance so as to promote the integration of the joint-insurance system, and enhance the ability of families to withstand and prevent the risk of higher medical expenses.