我国城镇职工基本医疗保险制度改革的经验与问题——基于对政策文件和制度环境的分析

文章分析了职工医疗保险20年来主要的政策文件及改革中面临的制度环境，总结了职工医疗保险制度变革的经验、存在的问题及其未来改革的建议。其经验是实施渐进改革，试点先行，保基本、多层次以及决策的科学化、民主化等，存在的问题是制度功能单一，政府责任缺失，缺乏顶层设计，与医疗服务市场缺乏有效的联动改革及数据匮乏等。最后，建议职工医疗保险坚持“保基本、多层次、可持续”方针；坚持渐进改革，试点先行；加强职工医疗保险制度顸层设计，实行联动改革；统一全国数据标准，建立数据质量评估体系和全国数据资料库等。

Experience and problems of Urban Employee Basic Medical Insurance reform in China: Based on analysis of Policy documents and institutional environment

This paper analyses the main policy documents of Urban Employee Basic Medical Insurance System(UEBMIS) over the past two decades and the institutional environment, experiences, and problems in the process of reform. We propose some recommendations for future reform. The experiences include gradually advancement reform, piloting first, ensuring basic demands, establishing multi-level security system and making decisions scientifically and democratically. Problems include single function, lack of government responsibility and top-level design, and lack of effective linkage with medical service market reforms and necessary data. In the future, UEBMIS should proceed according to the guideline of ensuring basic demands, establishing a multi-level security system, and ensuring sustainability. It should also proceed according to the guideline of gradual advancement and piloting first. Top-level design and linkage reform should be improved, national data should be unified, and a data-evaluation system should be established.