CAJ | 학술논문

基于改革的制度逻辑矫正,以及一系列政策措施来推进医疗医保体制机制和管理与服务创新,可有效达成新医改的区域整合制度安排。＂湛江模式＂的实质是引入社保基金的增值业务托管或增值再保险,建立微利型专业健康险代理制,继而尝试构建公共医疗医保的协同增值服务体系,核心是实现＂二次增值险＋第四方协同服务＂的城乡一体化健康保障普惠模式。此模式不仅为我国新医改的区域选择提供了成功样本,也为其他社会公共领域改革提供了借鉴。
기우개혁적제도라집교정,이급일계렬정책조시래추진의료의보체제궤제화관리여복무창신,가유효체성신의개적구역정합제도안배。＂담강모식＂적실질시인입사보기금적증치업무탁관혹증치재보험,건립미리형전업건강험대리제,계이상시구건공공의료의보적협동증치복무체계,핵심시실현＂이차증치험＋제사방협동복무＂적성향일체화건강보장보혜모식。차모식불부위아국신의개적구역선택제공료성공양본,야위기타사회공공영역개혁제공료차감。
Based on the reform of the system of the logic correction,and a series of policies and measures to promote medical security system mechanism and management and service innovation,which can effectively achieve new medical reform regional integration system arrangement.The essence of ＂Zhanjiang mode＂ is to set up micro profit professional health insurance agency system by introducing social security fund value-added custody or value-added reinsurance.It tries to establish public medical and health care collaborative value-added service system,finally to realize the universal health insurance of integration of urban and rural areas.The core is the realization ＂secondary value-added risks ＋ the fourth party collaborative services＂ of the urban and rural integration of the universal health insurance benefit pattern.This model is provide a successful sample not only for the country＇s new medical reform area selection,but also some reference for other social publicsector reform.