[1]于保荣,张 琼,郑艺慧.未来5~10年中国医疗保障待遇设计的改革思路[J].卫生经济研究,2024,41(02):19-22.
　YU Baorong,ZHANG Qiong,ZHENG Yihui.Reform Ideas for the Design of Medical Security Benefits in China in the next 5-10 Years[J].Journal Press of Health Economics Research,2024,41(02):19-22.
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未来5~10年中国医疗保障待遇设计的改革思路
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
41
期数:
2024年02期
页码:
19-22
栏目:
医疗保障
出版日期:
2024-01-30

文章信息/Info

Title:
Reform Ideas for the Design of Medical Security Benefits in China in the next 5-10 Years
作者:
于保荣1; 张 琼1; 郑艺慧1
1.对外经济贸易大学保险学院，北京 100029
Author(s):
YU Baorong;  ZHANG Qiong;  ZHENG Yihui
School of Insurance and Economics, University of International Business and Economics, Beijing 100029, China
关键词:
医疗保障制度; 保障待遇; 起付线; 报销比例; 封顶线
Keywords:
medical security scheme;  security benefits;  deductible;  coy-payment;  ceiling
分类号:
R197
文献标志码:
A
摘要:
医疗保障待遇包括起付线、报销比例、封顶线等内容。典型国家社会医疗保险报销起付线多设置在人均年收入的3%以内，对门诊、住院和药剂服务设立了不同的支付政策，医疗费用个人自付占可支配收入的比例在0.25%~2%。借鉴国际经验，展望中国社会医疗保险制度未来的发展，建议提高门诊保障待遇，以可支配收入为基数设置报销起付线，不同层级医疗机构实行相同的报销比例，设置个人自付封顶线，取消门诊报销封顶线，门诊和住院共用个人最高自付限额。
Abstract:
The design of benefit of health insurance scheme includes deductible, co-payment ratio and the ceiling. For typical health scheme the deductible usually is set within 3% of the national per capita annual income. Different payment policies are often established for outpatient, inpatient and pharmaceutical services. Individual out-of-pocket payments for annual medical expenses range 0.25%-2% of disposable income. Drawing on international experience and looking forward to the future development of China's social medical insurance system, the authors suggest to Improve outpatient security benefits, set up the deductible basing on disposable income, break the hierarchical reimbursement system, establish an out-of-pocket expenses ceiling, cancel the outpatients' reimbursement ceiling and merge it with the maximum out-of-pocket payment of inpatients.

参考文献/References:

[1] 李绍华，柴云主编.医疗保险支付方式[M].北京：科学出版社，2016：16-36.
[2] Medical insurance-compulsory insurance in Switzerland[EB/OL].[2009-06-22].https://www.swissinfo.ch/chi.
[3] CZ health insurance.Health insurance deductible:how it works[EB/OL].https://www.cz.nl/en/health-insurance/deductible.
[4] Global Health.Was ist ein Selbstbehalt und wie funktioniert er?[EB/OL].[2020-04-08].https://www.foyerglobalhealth.com/de/blog/was-ist-ein-selbstbehalt-und-wie-funktioniert-er.
[5] 日本厚生劳动省.G7各国的总医疗费（GDP比）和高龄化率的状况[EB/OL].https://www.mhlw.go.jp/content/12400000/0005925 06.pdf.
[6] The Henry J.Kaiser Family Foundation.Cost sharing for health care:France, Germany and Switzerland,vol.#7852.Washington offices and Barbara Jordan Conference Center,The Henry J Kaiser Foundation:2009.
[7] Tatara K,Okamoto E,Allin S,Matsuda R.Health care systems in tran-sition:Japan.Copenhagen:WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies,2009.
[8] Boyle S.Health care systems in transition:United Kingdom(England).Copenhagen:WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies,2011.
[9] Kilic M. Effects of contribution co-payments on health care and health financing in the German health care system[J].Eurasian Journal of Health Technology Assessment,2019,3(01): 16-28.

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更新日期/Last Update: 2024-01-30