中国医疗保险
中國醫療保險
중국의료보험
CHINA HEALTH INSURANCE
2015年
2期
17-19
,共3页
医疗保险%责任划分%统筹层次
醫療保險%責任劃分%統籌層次
의료보험%책임화분%통주층차
health insurance%division of responsibility%pooling levels
政府医疗保险责任包括制度设计、运行监管、资金支持。责任划分首先是政府与市场之间的划分：医疗保险基金自我平衡是其与政府财政责任的边界，政府作为最后责任人承担医疗保险运行失衡的财政托底责任。其次是政府体系内各级政府之间的划分。基金抵御风险的能力、道德风险的控制、异地就医即时报销的民意，三种力量决定中国医疗保险应选择“市级基金平衡+政府三级账户联网”管理模式。
政府醫療保險責任包括製度設計、運行鑑管、資金支持。責任劃分首先是政府與市場之間的劃分：醫療保險基金自我平衡是其與政府財政責任的邊界，政府作為最後責任人承擔醫療保險運行失衡的財政託底責任。其次是政府體繫內各級政府之間的劃分。基金牴禦風險的能力、道德風險的控製、異地就醫即時報銷的民意，三種力量決定中國醫療保險應選擇“市級基金平衡+政府三級賬戶聯網”管理模式。
정부의료보험책임포괄제도설계、운행감관、자금지지。책임화분수선시정부여시장지간적화분：의료보험기금자아평형시기여정부재정책임적변계，정부작위최후책임인승담의료보험운행실형적재정탁저책임。기차시정부체계내각급정부지간적화분。기금저어풍험적능력、도덕풍험적공제、이지취의즉시보소적민의，삼충역량결정중국의료보험응선택“시급기금평형+정부삼급장호련망”관리모식。
The responsibilities of government in health insurance include system design, operation supervision and financial support. Firstly, the division of governmental responsibility in health insurance begins with that of government and market:the homeostatic principle of health insurance fund is the boundary of governmental fiscal responsibility, and the government is the last person in charge of the health insurance fund imbalance. Secondly, it is the division within different levels of government system. Three factors, which include the ability of the fund to resist risks, the control of moral hazard and the desire of immediate reimbursement of remote medical care, determine the model of"Municipal level fund balance+Governmental three-level accounts network management"in Chinese health insurance system.
