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医保筹资与待遇调整关联机制研究

Research on the Mechanism Linking Health Insurance Financing and Treatment Adjustment

袁涛

医疗保险 集资 研究 中国 保险制度

2018-04-01

978-7-5203-2356-7

211

82

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  • 内容简介
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内容简介

筹资和待遇调整是医疗保障制度建设的核心。对医疗保险制度来说,理论上,保费核定是基于风险预测评估的结果,“以支定收”是其内在规律,但实践中我国城镇职工医保一直宣称坚持“以收定支”。
两个原则代表两种不同建制理念和管理服务模式,也关系着制度的福利成本。为了更好地维护社会医疗保险制度建设,本书从收支关联的视角,构建了适用于我国政策环境的医保筹资与待遇关联机制模型,用以分析和揭示我国社会医疗保险基金财务平衡的内在特点和发展规律。

Fund-raising and benefit adjustment are the core of the construction of the medical security system. For the medical insurance system, theoretically, premium determination is based on the results of risk prediction and assessment, and ‘revenue-based expenditure’ is its inherent law. However, in practice, China's urban employee medical insurance has always claimed to adhere to ‘expenditure-based revenue’.

These two principles represent two different concepts of system construction and management service models, and also relate to the welfare costs of the system. In order to better maintain the construction of the social medical insurance system, this book constructs a model of the relationship between medical insurance financing and treatment that is applicable to China's policy environment from the perspective of the correlation between revenue and expenditure, in order to analyse and reveal the inherent characteristics and development laws of the financial balance of China's social medical insurance funds.


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