走向全民医疗保险的实践与感悟

Abstract

深圳市全民医保具有鲜明特点，如制度覆盖面广，有多种形式的基本医疗保险供选择，参保资金补助渠道多，缴费水平低，医疗保险待遇水平高，保障范围宽，能够引导“小病在社区，大病进医院”的理性就医行为形成，方便参保人就医，实现了医疗保险“三项统筹”等。通过实践笔者认为，全民医保是大势所趋，公平与效率、大病与小病需兼顾，落实门诊统筹、保障社区首诊、实现市级统筹与城乡统筹等需要在制度设计中予以考虑，增加制度的灵活性和可选择性，增强制度自身的吸引力，变“要我参保”为“我要参保”。此外，政府重视与财政补助是实现全民医保的重要保证。

The characteristics of social medical insurance system of Shenzhen city is prominent. The medical insurance system covers all kinds of people in the city. There are several kinds of primary medical insurance institutions for different people to choose. The premiums is collected in multi-sources. The financing standard is low. The reimbursement level is high and the extent is broad. It leads the people participating medical insurance to the community health service centers to get the outpatient service and makes the people feel convenient. The insurance system also builds three kinds of mutual assistance funds. It is necessary to keep the balance between equity and efficiency, tiny illness protection and serious illness protection in the whole system. Some tasks should be considered such as to establish mutual assistance funds for general outpatient service, to collect mutual assistance funds for both the people living in city and countryside and to ensure the people to see doctors in the community health service centers in the first place. The government responsibility is also important for the achievement of medical insurance universal coverage.