暨南学报(哲学社会科学版)

作者：李珍

单位：中国人民大学健康保障研究中心。

关键词：基本医疗保险,强制参保,属地各参其保,家庭联保,居民医保费率制

基金：世界银行贷款现代财政制度与国家治理技援子项目“基本医疗保险参保机制”(2020K20071)。

基本医疗保险参保机制是指对参保人参保设置的规则条件,是制度公平、高效、可持续发展的基本前提。从高质量发展的要求看,我国基本医保在参保机制方面引致了许多问题:漏保人口绝对数量高;职工医保和城乡居民医保发展不平衡、城乡居民医保发展不充分;城镇职工一家多制、职工医保资金结余与家人保障不足并存;职工医保代际不公;城乡居民医保参保人保费负担不公平且制度筹资水平低等。本文在分析了现行参保机制和政策产生的历史背景下,基于对历史条件已经变迁的认识,建议改革相关参保机制与政策,提出了改革的配套措施以利改革顺利进行。本文主张实行强制参保、属地各参其保、职工家庭联保、退休人员缴费参保和居民医保费率制等,以推动医保高质量发展,满足人民群众日益增长的医疗保障需求。"/>template{display:none;}.mag-rich-xref-fn { cursor: pointer;}//长视频$(document).ready(function(){if($("#showLongArticleVideo") && $("#showLongArticleVideo").length && $("#showLongArticleVideo").length>0){mag_ajax_update({ele_id:'showLongArticleVideo',url:mag_currentQikanUrl() + "/CN/article/showLongArticleVideo.do?id="+$("#articleId").val()});}});$(document).ready(function(){window.metaData = {"journal":{"issn":"1000-5072","qiKanMingCheng_CN":"暨南学报（哲学社会科学版）","id":2,"qiKanMingCheng_EN":"Jinan Journal"},"fundList_cn":["世界银行贷款现代财政制度与国家治理技援子项目“基本医疗保险参保机制”(2020K20071)。"],"article":{"keywordList_cn":["基本医疗保险","家庭联保","居民医保费率制","强制参保","属地各参其保"],"juan":"44","zhaiyao_cn":"基本医疗保险参保机制是指对参保人参保设置的规则条件,是制度公平、高效、可持续发展的基本前提。从高质量发展的要求看,我国基本医保在参保机制方面引致了许多问题:漏保人口绝对数量高;职工医保和城乡居民医保发展不平衡、城乡居民医保发展不充分;城镇职工一家多制、职工医保资金结余与家人保障不足并存;职工医保代际不公;城乡居民医保参保人保费负担不公平且制度筹资水平低等。本文在分析了现行参保机制和政策产生的历史背景下,基于对历史条件已经变迁的认识,建议改革相关参保机制与政策,提出了改革的配套措施以利改革顺利进行。本文主张实行强制参保、属地各参其保、职工家庭联保、退休人员缴费参保和居民医保费率制等,以推动医保高质量发展,满足人民群众日益增长的医疗保障需求。","endNoteUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/article/getTxtFile.do?fileType=EndNote&id=6621","bibtexUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/article/getTxtFile.do?fileType=BibTeX&id=6621","abstractUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/10.11778/j.jnxb.20221420","qi":"11","id":6621,"nian":2022,"bianHao":"2022-11-69","zuoZheEn_L":"LI Zhen","juanUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/Y2022","shouCiFaBuRiQi":"2023-01-11","qiShiYe":"69","qiUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/Y2022/V44/I11","lanMu_cn":"社会保障研究","pdfSize":"691","zuoZhe_CN":"李珍","risUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/article/getTxtFile.do?fileType=Ris&id=6621","title_cn":"基本医疗保险参保机制改革的历史逻辑与实现路径","doi":"10.11778/j.jnxb.20221420","jieShuYe":"79","keywordList_en":["basic medical insurance","domestic medical insurance rate system","family joint insurance","locally-driven individual participation of medical insurance","mandatory insurance participation system"],"endNoteUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/article/getTxtFile.do?fileType=EndNote&id=6621","zhaiyao_en":"The medical insurance participation mechanism refers to the rules and conditions set for the insured, which is the basic premise of fair and sustainable development of the system. Although China's urban workers' medical insurance and urban and rural residents' medical insurance have achieved the basic full coverage of the population, from the requirement of high-quality development, the basic medical insurance still faces some problems in terms of the system: some people have missed insurance; the development of medical insurance for employees and urban and rural residents is unbalanced, and the medical insurance for urban and rural residents is inadequate; the premium burden of urban and rural residents' medical insurance participants is unfair and the system financing level is low; the multi-family system of urban workers, the balance of employees' medical insurance funds and the lack of family security coexist; inter-generational injustice of medical insurance for employees, etc. The main problems are that the number of employees participating in medical insurance is too small, the financing ability of urban and rural residents is insufficient, and its protection is limited. This paper suggests reforming the basic medical insurance participation mechanism, realizing everyone's insurance and solving the problem of unfair burden of premium. At the same time, by increasing the number of employees' medical insurance participants and decreasing the number of residents' medical insurance participants, the problems of unbalanced development of the two systems of employees and residents and insufficient financing of medical insurance for urban and rural residents can be solved, so as to meet the people's growing demand for health protection.","bibtexUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/article/getTxtFile.do?fileType=BibTeX&id=6621","abstractUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/10.11778/j.jnxb.20221420","zuoZheCn_L":"李珍","juanUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/Y2022","lanMu_en":"","qiUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/Y2022/V44/I11","zuoZhe_EN":"LI Zhen","risUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/article/getTxtFile.do?fileType=Ris&id=6621","title_en":"Reforming the Participation Mechanism of Basic Medical Insurance to Promote the High-Quality Development of Basic Medical Insurance","hasPdf":"true"},"authorNotes_cn":["李珍,中国人民大学健康保障研究中心。"]};if(window.metaData && (!window.metaData.authorNotesCommon_cn && !window.metaData.authorNotesCorresp_cn && window.metaData.authorNotes_cn)){window.metaData.authorNotesCommon_cn = window.metaData.authorNotes_cn;}if(window.metaData && (!window.metaData.authorNotesCommon_en && !window.metaData.authorNotesCorresp_en && window.metaData.authorNotes_en)){window.metaData.authorNotesCommon_en = window.metaData.authorNotes_en;}var _nlmdtdXml = $("#article_nlmdtdXml").val();var magDir = _nlmdtdXml.replace(/\/[^\/]+$/,'');window.metaData.magDir = magDir;new mag_vue({ el: '#metaVue', //dataUrl: mag_currentQikanUrl() + '/EN/article/getRichHtmlJson.do?articleId='+$("#articleId").val(), data:window.metaData, loading:true, doTextFun:function(text){ return doDataJsonText(text); }, doAfterFun:function(selector,jsonData){doMagVueAfter(selector,jsonData);}});var pars = {attachType:'PDF',id:$("#articleId").val(),json:true};jQuery.post($("#mag-common-contextPath").val()+"/CN/article/showArticleFile.do?" + new Date().getTime(), pars, function(data){var json=null;if(data.match(/^\[json\].*/g)){json=eval("("+data.replace(/^\[json\]/g,"")+")");}if(json && json.status == 1){//有权限}else{//无权限$("#no-access-div").show();}});mag_ajax({url:mag_currentQikanUrl() + '/CN/article/getRichHtmlJson.do',data:{articleId:$("#articleId").val(),token:'5cbeb2d06ad84be88b1c7bd7ec69a93c',referer:document.referrer},dataType:"json",async:"false",success:function(json){if(json.richHtmlJson && json.richHtmlJson.article){if(json.trans){var _nlmdtdXmlCN = $("#article_nlmdtdXmlCN").val();var magDirCN = _nlmdtdXmlCN.replace(/\/[^\/]+$/,'');json.richHtmlJson.magDir=magDirCN;}else{json.richHtmlJson.magDir=magDir;}new mag_vue({ el: '#bodyVue', data:json.richHtmlJson, doTextFun:function(text){ return doDataJsonText(text); }, doAfterFun:function(selector,jsonData){doMagVueAfter(selector,jsonData);}});}}});//altmetricif($.trim($("#article_doi").val())!=''){$.ajax({url:'https://api.altmetric.com/v1/doi/'+$.trim($("#article_doi").val())+'?callback=altmetric_callback',//url:'https://api.altmetric.com/v1/doi/10.1007/s13238-016-0264-7?callback=altmetric_callback',dataType:'jsonp'});}mag_rich_menu(jQuery);$(function(){ $('#autoMenu').autoMenu();})$("#autoMenu").niceScroll({cursorcolor: "#ccc", //滚动条的颜色cursoropacitymax: 0, //滚动条的透明度，从0-1 touchbehavior: false, //使光标拖动滚动像在台式电脑触摸设备 true滚动条拖动不可用 cursorwidth: "6px", //滚动条的宽度 单位默认px cursorborder: "0", // 游标边框css定义 cursorborderradius: "3px", //滚动条两头的圆角 autohidemode: true, //是否隐藏滚动条 true的时候默认不显示滚动条，当鼠标经过的时候显示滚动条 zindex: "auto", //给滚动条设置z-index值 railvalign:'defaul',railpadding: {top: 0,right: -6,left: 0,bottom: 0}, //滚动条的位置});window.autoMenuFlag=true;$("#relatedArticles").niceScroll({cursorcolor: "#ccc", //滚动条的颜色cursoropacitymax: 0, //滚动条的透明度，从0-1 touchbehavior: false, //使光标拖动滚动像在台式电脑触摸设备 true滚动条拖动不可用 cursorwidth: "6px", //滚动条的宽度 单位默认px cursorborder: "0", // 游标边框css定义 cursorborderradius: "3px", //滚动条两头的圆角 autohidemode: true, //是否隐藏滚动条 true的时候默认不显示滚动条，当鼠标经过的时候显示滚动条 zindex: "auto", //给滚动条设置z-index值 railvalign:'defaul',railpadding: {top: 0,right: -6,left: 0,bottom: 0}, //滚动条的位置});//公式序号 居右jQuery(".mag-xml-disp-formula").each(function() {var _this = jQuery(this);var _label= _this.children("label");if(typeof(_label.html())!="undefined"){_this.children("label").remove();_this.wrap("");_this.parent().parent().append(""+_label.html()+"");}});$('body').click(function(){$('.daochu_div').hide();$('.qipao').hide();})$('.qipao').click(function(event){event.stopPropagation();})/*参考文献显示隐藏*/$('.biaotijiantoush1').click(function(event){if($(this).attr('class')=='glyphicon glyphicon-triangle-top biaotijiantoush biaotijiantoush1'){$(this).parents('.mag_main_zhengwen_left_div_ckwx_table_benwenyiny').next('.mag_main_zhengwen_left_div_ckwx_table_ckwx_xiangqing').stop().slideUp();$(this).attr('class','glyphicon glyphicon-triangle-bottom biaotijiantoush biaotijiantoush1');}else if($(this).attr('class')=='glyphicon glyphicon-triangle-bottom biaotijiantoush biaotijiantoush1'){$(this).parents('.mag_main_zhengwen_left_div_ckwx_table_benwenyiny').next('.mag_main_zhengwen_left_div_ckwx_table_ckwx_xiangqing').stop().slideDown();$(this).attr('class','glyphicon glyphicon-triangle-top biaotijiantoush biaotijiantoush1');}event.stopPropagation();});//加载补充材料mag_ajax_update({ele_id:'showArticle_suppls',url:mag_currentQikanUrl() + '/CN/article/showArticleSuppls.do',data:{articleId:$("#articleId").val()}});//加载专题mag_ajax_update({ele_id:'showArticle_subjects',url:mag_currentQikanUrl() + '/CN/subject/showSubjectListByArticle.do',data:{articleId:$("#articleId").val(),forwardJsp:'showArticle'}});//渲染公式mag_mathJax();});function altmetric_callback(json){if(json && json.score){if(json.score - parseInt(json.score) > 0){$("#altmetric-score").html(parseInt(json.score)+1);}else{$("#altmetric-score").html(parseInt(json.score));}$(".main_content_center_right_duoweidu_div").css("width","25%");$("#altmetric-a").show();$("#altmetric-a").attr("href",json.details_url);}}function richClickAuthor(name){var searchSQL = "((("+mag_advSearchValReplace(name)+"[Author]) AND 2J[Journal]) AND year[Order])";mag_request({url:mag_currentQikanUrl() + '/CN/searchresult',data:{searchSQL:searchSQL}});}function richClickKeyword(keyword){var searchSQL = "((("+mag_advSearchValReplace(keyword)+"[Keyword]) AND 2J[Journal]) AND year[Order])";mag_request({url:mag_currentQikanUrl() + '/CN/searchresult',data:{searchSQL:searchSQL}});}function mag_share(){$("#bShare_more_a").click();}function loadRelatedArticles(){if($("#showRelatedArticles") && $("#showRelatedArticles").length>0){//加载过了}else{mag_loading();mag_ajax_update({ele_id:'relatedArticles-content',url:mag_currentQikanUrl() + '/CN/article/relatedArticle.do',data:{id:$("#articleId").val(), forwardJsp:'showArticle'},complete:function(){mag_layer_close();}});}}function showMetrics(){mag_window_location(mag_currentQikanUrl() + '/CN/metrics/'+$("#articleId").val());}function piaofuFn(a,fnId){var content=''+$("#mag-rich-fn-"+fnId).html()+'';piaofu(a,content);}function huoqukuanduimg(){//}function doDataJsonText(text){var str = text;//var _nlmdtdXml = $("#article_nlmdtdXml").val();//var magDir = _nlmdtdXml.replace(/\/[^\/]+$/,'');str = str.replace(/";ss += "";var shuomingTitle = "";var shuomingContent = '';if(fig.titleCn && fig.titleCn!=''){shuomingTitle = fig.titleCn;if(fig.titleContentCn && fig.titleContentCn!=''){shuomingContent += fig.titleContentCn;}}if(shuomingTitle==''){if(fig.titleEn && fig.titleEn!=''){shuomingTitle = fig.titleEn;}if(fig.titleContentEn && fig.titleContentEn!=''){shuomingContent += fig.titleContentEn;}}else{if(fig.titleEn && fig.titleEn!=''){shuomingContent += ""+fig.titleEn+"

来源：2022年第11期

《暨南学报(哲学社会科学版)》期刊编辑部

查看暨南学报(哲学社会科学版)杂志2022年第11期