基于内蒙古自治区城乡居民基本医疗保险一体化的综合模拟测算

目的:综合考虑内蒙古自治区城乡居民基本医疗保险的现状,在确保城乡居民基本医疗保险缴费比率不大幅提升的基础上,考虑起付线与封顶线等因素,综合测算政府、社会和个人三大筹资主体的筹资比例与额度,分析合理的自治区城乡居民基本医疗保险一体化对接模式。方法:本研究创新性地将精算模型与ProModel系统仿真相结合,对起付线、封顶线等因素加以考虑,并对自治区城乡居民基本医疗保险一体化进行综合模拟测算。资料来源于2007-2018年内蒙古自治区卫计委数据、中国统计年鉴与前期的研究成果。结果:(1)居民个人筹资额度不断增加,且从2014年至2018年,增长幅度在60%以上,但可行性依然较强。(2)政府与社会筹资额度不断增加,年增长幅度在20%以上,筹资能力面临挑战。结论:积极关注城乡居民自付费用,构建以基本医疗保险为主导,商业医疗保险为辅助的多维保险体系。     

整合城乡居民基本医疗保险制度筹资政策分析——基于公平性视角

目的:从公平性角度对新农合与居民医保制度的筹资政策进行分析。方法:收集2008—2015年新农合和居民医保的筹资数据,新农合数据来自于中国卫生统计年鉴(2009—2012),中国卫生和计划生育统计年鉴(2013—2016)和新型农村合作医疗统计信息手册(2008—2015),居民医保数据主要来自中国劳动统计年鉴(2009—2016)和中国社会保险年鉴(2009—2015)。采用了根据支付能力筹资的方式来衡量城乡居民医保筹资的公平性。选择个人缴费占城乡居民人均可支配收入的比例作为比较医保筹资公平性的具体指标。结果:新农合和城镇居民医保筹资机制类似,个人缴费占人均筹资额比例低于1/4。人均筹资额占农村居民人均纯收入和城镇居民人均可支配收入的比例分别低于2%和5%,而个人缴费占农民人均纯收入和城镇居民人均可支配收入的比例低于1%。居民医保和新农合个人缴费占城乡居民人均可支配(纯)收入比例的差距有所扩大。结论:居民医保和新农合个人缴费占人均可支配收入比例低。农村居民和城镇居民医保采取的平等筹资掩盖了城乡居民在医保筹资方面的不公平性。     

广西城乡居民基本医疗保险运行状况分析

广西城镇居民基本医疗保险和新型农村合作医疗这两项制度在筹资模式、筹资水平、保障水平等主要方面都很相近,并且两项制度在运行中都存在着经办管理能力不足、待遇水平低下、基层医疗服务平台滞后等问题.可以将这两项制度整合统一,建立统一的城乡居民基本医疗保险制度.     

上海城乡居民医疗保险筹资满意度分析

目的了解居民对城乡居民医疗保险筹资结构满意度及影响因素,为完善上海城乡居民医疗保险筹资制度提供政策建议。方法采用分层随机抽样的方法,自行设计调查问卷,对386名上海城乡居民医疗保险的参保者进行调查,以了解参保居民对城乡居民医疗保险筹资结构的认知度、满意度和期望度。所得数据采用多元logistic回归方法进行统计,检验收入、年龄、身体健康状况、缴费档次、享受水平对筹资结构满意度的影响,分析上海居民医疗保险的筹资满意度并提出建议。结果上海城乡居民对筹资结构的满意度不高,其中城乡居民的收入、年龄是影响筹资结构满意度的主要因素。结论政府应该基于收入设计筹资方案;保证筹资与待遇相匹配;优化政府财政投入结构;逐步取消个人账户,建立统一的国民健康保险。     

The cost of coverage: rural health insurance in China

China has undergone great economic and social change since 1978 with far reaching implications for the health care system and ultimately for the health status of the population. The Chinese Medical Reform of the 1980s made cost recovery a primary objective. The urban population is mostly protected by generous government health insurance. A high share government budget is allocated to urban health care. Rural cooperative health insurance reached a peak in the mid-1970s when 90% of the rural population were covered. In the 1980s rural cooperative health insurance collapsed and present coverage is less than 8%. The decline has been accompanied by reports of growing equity problems in the financing of and access to health care. This article is the first in a four-year study of the impact on equity of the changes in Chinese health care financing. The article examines the relationship between rural cooperative health insurance as the explanatory variable and health care expenditure, curative vs. preventive expenditure and tertiary curative care expenditure as dependent variables using a natural experimental design with a 'twin' county as a control. The findings support the hypothesis that cooperative health insurance will induce higher growth of health care expenditure. The findings also support the hypothesis that cooperative health insurance will lead to a shift from preventive medicine to curative medicine and to a higher level of tertiary curative care expenditure. The empirical evidence from the Chinese counties is contradicting World Bank health financing policies.     

Survey of health needs and concerns of rural Pennsylvanians

INTRODUCTION: This survey was undertaken to determine the most important health and safety needs of farmers and rural citizens of Pennsylvania. METHODS: In June of 2004, a one-page questionnaire was distributed by mail to 32,700 members of the Pennsylvania Farm Bureau as an attachment to their monthly newsletter. RESULTS: The lack of affordable health care insurance was overwhelmingly cited as the most important unmet health care need (73%). No other issue was chosen by more than 10 percent of respondents. This lack of affordable health insurance was also cited as the most important health or safety problem to be addressed in the respondent's communities (71%). When asked the most important health or safety problem affecting them as individuals or their community, the respondents chose "no major problem or need" as the most frequent response (46%). The issue of affordable health insurance was not an option for this question. The predominant concern regarding the lack of affordable health insurance was consistent across all regions of the Commonwealth and for farmers as well as residents of all community sizes sampled. DISCUSSION: This study would indicate that the lack of affordable health insurance is the preeminent health and safety issue for many Pennsylvania farmers and rural citizens.     

论建立低价格的农村医疗卫生体系运行机制

农村合作医疗制度在全国绝大多数农村地区已经崩溃 ,医疗保障制度缺失已成为农村不稳定因素之一。政府应承担建立和完善低价格农村医疗卫生体系运行机制的责任 ,建立一种半商业性质、半社会保障性质的农村居民医疗保险 ,部分解决农民的大病医疗问题 ,直接向农民发放医疗券 ,以基金项目运作的方式 ,改善农村的公共卫生条件 ,调整扶贫资金的使用方向等等 ,都是建立这一运行机制的可行性尝试。     

北京市医改三年卫生总费用分析

目的：分析2009-2011年北京市卫生筹资水平、结构及变化趋势.方法：利用筹资来源法核算卫生总费用,卫生费用评价方法进行数据分析.结果：2009-2011年,北京市卫生总费用从689.60亿元增长到977.26亿元,年均增长12.42％,人均卫生总费用年均增长4.82％;城乡居民个人现金卫生支出占可支配收入（纯收入）及占消费性支出的比重均呈下降趋势;社会医疗保障经费年均增长19.36％,占卫生总费用比重增加5.44％.结论：医改三年政府对卫生投入力度加大,卫生筹资结构更加合理;社会医疗保障范围不断扩大,实现城乡居民全覆盖,医疗保障经费增长迅速;居民就医负担呈下降趋势,但城乡就医负担差异明显.建议：扩大卫生筹资渠道,深入分析卫生筹资差异存在的原因.     

城乡大病医保实施中存在的问题及政府责任探讨——基于辽宁实践的研究

阐述了辽宁省城乡大病保险制度实施情况,分析了全面实施城乡大病保险制度中存在的问题及政府责任,并提出通过加强制度设计,统筹协调配置资源,强化筹资调控能力、注重监管防治风险等方式来完善制度运行,为居民提供优质健康保障,促进卫生事业长远发展。     

基于时间序列数据的北京市卫生筹资水平、构成趋势研究

目的:分析评价北京市基于时间序列的卫生筹资总额、结构变化等。方法:卫生总费用筹资来源法。结果:2000—2016年北京市卫生筹资总额从166.72亿元增长到2 048.99亿元,平均增长速度为13.00%,人均卫生总费用从1 222.65元增长到9 429.73元,卫生总费用占GDP的比重从5.27%增长到7.98%,城乡居民就医负担总体呈下降趋势,但城乡差异较大。结论:北京市卫生总费用变化体现宏观政策变化,社会卫生支出高速增长,政府对卫生筹资贡献的影响力减弱,个人现金卫生支出占总筹资比重下降,城乡居民就医负担有所缓解。建议:保证政府卫生投入的可持续性,规范发展商业健康保险,引导社会资本流入医疗,拓宽社会筹资渠道,控制个人现金卫生支出占比。     

浙江省嘉兴市新农合与城镇居民医保整合的探索与实践

2003年浙江省嘉兴市各县（市、区）成为全国首批新农合试点城市。十年来,嘉兴市结合经济社会发展特点,积极探索新型农村合作医疗和城镇居民基本医疗保障制度整合,建立了城乡居民合作医疗保险制度,实现了城乡居民医疗保障一体化和医疗保障全覆盖。通过加大政府投入,完善补偿方案,城乡居民的医疗保障水平不断提高,结合公立医院改革和基层卫生改革试点工作,多措并举,实现了城乡居民合作医疗保险费用有效控制,提高了卫生资源和医疗保障资源的有效利用,促进了基层医疗卫生服务的良性发展,巩固发展了城乡居民合作医疗保险制度,提高了城乡居民的健康水平。     

Reforming China's urban health insurance system

China's urban health insurance system is mainly consisted of labor insurance schemes (LIS) and government employee insurance scheme (GIS). LIS is a work unit-based self-insurance system that covers medical costs for the workers and often their dependents as well. GIS covers employees of the State institutions, is financed by general revenues. Since 1980s, China has implemented series of health insurance system reforms, culminating in the government's major policy decision in December of 1998 to establish a social insurance program for urban workers. Compared with the old insurance systems under LIS and GIS, the new system expands coverage to private sector employees and provides a more stable financing with its risk pool at the city level. Despite of these advantages, implementation of China's health insurance reform program is faced with several major challenges, including risk transfer from work units to municipal governments, diverse need and demand for health insurance benefits, incongruent roles of the central and regional governments. These challenges may reflect practical difficulties in policy implementation as well as some deficiencies in the original program design.     

我国城镇儿童医疗保险的筹资研究

我国城镇儿童被纳入居民基本医疗保险,各地试点方案均设定了较低的筹资标准和较高的政府补助,在一定程度上反映了儿童健康的特点以及政府对儿童的保障意愿和筹资支持能力.但自愿参保、"以家庭为主"的筹资等制度设计使儿童医疗保险存在公平性不足、不确定性、政府投入资源转移使用等问题.在现有保障水平下,建议由政府筹资覆盖全体儿童,优先...     

居民卫生筹资与医疗费用负担实证分析：以上海为例

降低居民医疗负担是本轮医改的重要目标,了解和分析居民医疗负担是采取针对性措施推进相关改革的基础。本文从宏观层面分析了上海市居民在卫生筹资中的负担,从微观层面分析了其在医疗费用中的自付比例,并分析了不同人群医疗费用负担分布情况。发现上海市居民个人现金卫生支出占卫生总费用比例处于较低水平,医疗费用中医保报销比例较高;但医疗费用中,医保报销范围外自付费用高,且医疗费用负担在不同年龄组、不同医保类型、城乡人群中分布不均衡,造成医疗费用负担重的情况仍然存在。建议长期监测居民医疗费用负担情况,对重点人群“靶向”减负,加大自付费用控制力度等。     

新型农村合作医疗政策存在的问题及未来改革模式探讨

从2003年我国实施新型农村合作医疗（简称新农舍）制度以来取得了显著的成绩,在一定程度上缓解了农村居民“看病难、看病贵”问题,但是在制度推行过程中,也逐步暴露出新的问题和矛盾,制约着新农合的发展,致使全国一些地方对新农合有了各种新的实践探索。本课题组在对新农合存在问题总结分析的基础上,认为新农合的未来模式应该符合我国经济社会发展趋势和医疗保障体制改革的目标,即全民医保一体化,从而设想一种新模式：“全民基本医疗保险＋补充医疗保险＋医疗救助”来规避制约新农合发展的因素．逐步实现农村居民、城镇居民的医保统一。     

国际精神卫生筹资现状及对我国的启示

财政投入不足及资金使用效率不高是全球范围内精神卫生服务领域面临的共同困境。国际上普遍采取的精神卫生筹资渠道有税收、社会保险和自费等,其中政府是最主要的筹资主体。我国精神卫生筹资总体水平较低,公平性差,且资金分配机制不合理。本文认为,为完善我国精神卫生筹资政策,需将卫生筹资纳入精神卫生法和精神卫生工作纲要,并明确政府尤其是中央政府对精神卫生的财政投入责任,在资金分配中向社区倾斜,提高资金使用效率。     

天津市基本医疗保险制度公平性评价

目的:对天津市基本医疗保险制度的公平性进行评价,分析公平性方面存在的问题。方法:从横向和纵向两个方面评价天津市基本医疗保险制度的公平性,横向采用参保、筹资、医疗服务利用公平性等指标评价,纵向分析人口老龄化和现收现付制,以及个人账户对医疗保险公平性的影响。结果:参保机会、城乡居民筹资较公平;不同收入人群间的基金筹集、职工实际筹资负担率、城乡居民医疗服务利用、代际之间以及个人账户方面存在一定的不公平。结论:继续扩大医保覆盖范围,根据收入差异制定不同的缴费额、起付线和封顶线,完善社区卫生服务体系,逐步建立和完善老年护理保险制度,取消退休人员的基本医疗保险个人账户。     

Equity in health and health care: the Chinese experience.

This paper examines the changes in equality of health and health care in China during its transition from a command economy to market economy. Data from three national surveys in 1985, 1986, and 1993 are combined with complementary studies and analysis of major underlying economic and health care factors to compare changes in health status of urban and rural Chinese during the period of economic transition. Empirical evidence suggests a widening gap in health status between urban and rural residents in the transitional period, correlated with increasing gaps in income and health care utilization. These trends are associated with changes in health care financing and organization, including dramatic reduction of insurance cover for the rural population and relaxed public health. The Chinese experience demonstrates that health development does not automatically follow economic growth. China moves toward the 21st century with increasing inequality plaguing the health component of its social safety net system.     

我国农村医疗卫生体制分析

近几年来，随着农民收入的增长相对缓慢，政府对农村卫生资金投入不足，造成农村卫生人才缺乏，基础设施落后，某些地方传染病、地方病有所抬头，医疗费用居高不下，农民因病致贫、因病返贫现象突出，农村合作医疗举步艰难等等。建议：(1)继续深化卫生服务体系改革。(2)增强政府筹资的作用.     

我国医保制度整合的相关问题探讨

针对我国目前医疗保险制度存在碎片化状况,提出了医保制度整合中需要重点关注的几个问题：整合应以总体规划分步实施、立法保障稳步推进、公平优先兼顾效率为原则,分三个步骤进行;在筹资方面,应逐步实现强制参保,以家庭为参保单位,并以法律形式明确各级政府的筹资责任,设置分档次的居民筹资方式及合理的补偿机制;在管理上,应妥善整合经办管理机构,并通过立法明确基金监管和服务质量保障机制,确保监管有效、得力。