从分级治理到央地协同:基本医疗保险地区差异的实践特征、影响效应与治理路径被引量：4

From Tiered Governance to Central-Local Coordination:Characteristics,Impacts,and Governance Pathways of Regional Disparities in Basic Medical Insurance

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摘要我国医疗保障制度的一个突出问题是地区不平衡性,具体表现为基金收支、筹资标准、待遇水平、政策设计等多方面的地区差异,导致制度公平性不足、共济性弱、管理难度大、个体风险保障缺乏精准性等问题;长期来看会影响劳动力自由流动、加剧个体不公平和地区不平衡,不利于共同富裕目标的实现。试点先行的历史路径确立了属地管理的基本原则,叠加制度统一与分级治理的宏观治理体系共同塑造了我国基本医保的地区不平衡性。为着力解决医保发展不平衡、不充分的问题,需要基于区域共济和央地协同的思路,通过强化顶层设计、理顺管理体制、推进医保区域制度一体化、技术赋能医保服务、探索更加精准的财政补贴等措施,弱化属地责任分级管理体系的组织弊端,破除导致基本医保区域不平衡的体制机制障碍,实现面向共同富裕与中国式现代化的基本医疗保险区域协调发展。 A significant fault line within China's medical insurance system is regional imbalance,which manifests across various dimensions,including fund revenue and expenditure,financing,benefits,and policy design.These disparities result in insufficient fairness,weakened solidarity,challenging management,and inadequate risk protection for individuals.In the long term,they can adversely aff ect the free movement of labor and exacerbate inequalities,thereby undermining the goal of common prosperity.Historically,a pilot-first approach established the principle of local management,compounded by a macro governance framework integrating institutional unity and tiered governance.Together,these factors have contributed to the regional imbalances in basic medical insurance.To effectively address the issues of uneven and inadequate development in medical insurance,it is essential to adopt an approach that fosters solidarity between regions and enhances central-local coordination.Recommended measures include improving top-level design,streamlining management systems,promoting the integration of regional medical insurance schemes,leveraging technology to enhance insurance services,and exploring more precise fi scal subsidies.These actions aim to mitigate the organizational drawbacks of tiered local responsibility,dismantle the systemic barriers leading to regional imbalances in basic medical insurance,and facilitate the coordinated development of basic medical insurance in alignment with common prosperity and Chinese-style modernization.

作者王昭茜 Wang Zhaoxi(School of Public Administration,Northwest University,Xi'an 710127,China)

机构地区西北大学公共管理学院

出处《社会保障评论》 CSSCI 2024年第6期89-105,共17页 Chinese Social Security Review

基金 “国家资助博士后研究人员计划”项目(GZC20241383)。

关键词基本医疗保险医保治理地区差异公平统一 basic medical insurance medical insurance governance regional disparities fairness and unity

分类号 R197.1 [医药卫生—卫生事业管理] F842.684 [经济管理—保险]

作者简介王昭茜,西北大学公共管理学院讲师。主要研究方向:医疗保险。