全民医保单一保险人与多元保险人模式比较

采用文献研究法,从人群覆盖、筹资政策、给付项目、保障待遇、基金管理和定点管理六个方面,分析单一保险人和多元保险人的含义、特征和优缺点。我国全民医保一体化的方向是实行单一保险人模式,有助于实现公平可及的全民医保覆盖、有效控制医疗费用过快增长;但也可能面临着医疗品质下降的风险。对此建议我国在全民医保一体化改革中实行强制参保,建立以扩充保费基数为基础的多元筹资体系,实施总额控制下的多元复合式支付方式。

Comparison of National Medical Insurance Single Insurer and Multi-insurer Models

The literature research method was used to analyze the definition,characteristics,advantages and disadvantages of single and multiple insurers from six aspects:population coverage,financing policies,payment items,guarantee benefits,fund management and designated management.The integration direction of China's national medical insurance is to implement a single insurer model,which will help achieve fair and universal coverage of national medical insurance and effectively control the excessive growth of medical expenses.However,it may also face the risk of medical quality degradation.So it is suggested that China should implement compulsory insurance participation in the reform of the national medical insurance integration,establish a multi-funding system based on expanding the medical insurance payment base,and implement a multi-compound payment method under total control.