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随着我国医疗卫生投入不断增加,我国基本实现了全民医保,覆盖率和保障水平都有了较大提升,但是国民似乎并没有在这个过程中明显受益。“看病难、看病贵”问题也没有得到根本解决,我国医疗保障陷入“无感增长”困境。造成这种情况的原因,除了城乡居民医疗支出超过收入增长、农村居民医疗保健支出占消费支出的比重不断提高等,医疗支出的健康效用边际递减之外,大病风险不断上升,而大病保障体系发展相对滞后,大病给国民带来的损失大于医保带来的效用,这也是导致医疗保障“无感增长”的重要原因。本文提出从权利贫困视角扩展国民化解健康风险的权利集,提高经办机构服务能力,明确制度边界,构建无缝衔接的大病保障体系,转变医疗保障理念,才能促进我国医疗保障制度的转型。
With the increasing investment in medical and health care in our country, we have basically achieved universal coverage of medical insurance. The coverage rate and the level of protection have all been greatly improved. However, the nationals do not seem to have obviously benefited from this process. “Difficult to see a doctor, expensive doctor ” problem has not been fundamentally resolved, China s medical insurance fell into “no sense of growth ” dilemma. The reasons for this are as follows: Except for urban-rural residents whose medical expenses exceed income growth, the proportion of rural residents in health care expenditures as a proportion of consumer spending continues to rise, and the health utility of medical expenditures decreases marginally, the risk of serious illness is on the rise, while the development of serious illness protection systems Relatively backward, the serious illness caused to the citizens is greater than the loss brought by the medical insurance, which is also an important reason leading to medical insurance “no sense of increase ”. This paper puts forward that it is necessary to expand the rights of nationals to resolve health risks from the perspective of rights and poverty, improve the service ability of handling agencies, clarify the system boundaries and construct a serious illness guarantee system that seamlessly connects with each other and change the concept of medical insurance so as to promote the transformation of China’s medical insurance system.