通讯作者: 龚曦, xigong0504_xg@163.com

DOI：10.12201/bmr.202108.00014

A longitudinal comparative study of social medical insurance policies from the perspective of welfare incidence

• 摘要：为了促进基本医疗保险政策的高质量协调发展，本文从福利归属的视角对我国基本医疗保险政策进行审视和分析。本文认为社会医疗保险政策的福利归属主要包括三个面向，分别是医保政策的覆盖情况，医保政策受益的分布情况和疾病风险负担的分布情况。就每个维度而言，政策覆盖维度包括医保的参保率与未参保率，尤其要关注未参保群体的基本特征；医保政策受益维度主要关注受益在不同群体之间的分布情况；疾病风险负担维度主要关注疾病负担在不同群体之间的分布情况。利用中国综合社会服务调查数据(CGSS)和中国家庭金融调查数据(CHFS)等多源数据库进行分析，得出基本结论如下：基本医保的参保率实现了较高水平，但未参保群体中农村群体和低收入群体占比有提高的趋向；基本医疗保险的受益具有一定的亲富性，并具有强化趋向；而疾病负担具有一定的亲贫性，也具有强化趋向。因此，需要明确规定基本医疗保险参保的强制性，合理调整基本医疗保险政策的保障范围，以及完善面向弱势群体倾斜的医保补偿政策。

  关键词： 福利归属; 社会医疗保险政策; 覆盖率; 受益归属; 疾病负担

   

  Abstract: In order to promote the high-quality and coordinated development of basic medical insurance policy, this paper examines and analyzes the basic medical insurance policy in China from the perspective of welfare attribution. This paper holds that the welfare incidence of social medical insurance policy includes three dimensions, which are the coverage of the insurance policy, the distribution of benefits of the insurance policy and the distribution of the disease risk burden. In terms of each dimension, policy coverage includes the insured rate and the noninsured rate, especially the basic characteristics of the uninsured groups. The benefit dimension of medical insurance policy mainly focuses on the distribution of benefits among different groups. The dimension of disease risk burden mainly focuses on the distribution of disease burden among different groups. The basic conclusions are as follows: the participation rate of medical insurance has been high, but the proportion of rural and low-income groups in uninsured groups is increasing. The benefits of medical insurance have some pro rich nature and have the tendency of strengthening. The disease burden has pro poor and has the tendency of strengthening. Therefore, it is necessary to stipulate the compulsory participation of medical insurance clearly, adjust the scope of basic medical insurance policy reasonably, and improve the policy of medical insurance compensation for vulnerable groups.

  Key words: Welfare ownership; Social medical insurance policy; Coverage rate; benefits incidence; Disease burden

  提交时间：2021-10-08

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2021-08-20	bmr.202108.00014V1	下载

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