Moving towards universal health insurance in China: Performance, issues and lessons from Thailand
Moving towards universal health insurance in China: Performance, issues and lessons from Thailand
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中国迈向全民健康保险：泰国的表现、问题和教训
DOI：
10.1016/j.socscimed.2011.06.002
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发表时间：
2011-08-01
影响因子：
5.4
通讯作者：
Yu, Min
中科院分区：
文献类型：
--
作者：
Li, Cheng;Yu, Xuan;Yu, Min
中国目前正在实施新一轮的医疗体制改革。通过基本社会医疗保险制度实现全民医保是改革议程上的重中之重。本文在文献回顾和公开数据的基础上，从税收征收、风险分担、福利方案和医疗机构支付机制等方面考察了中国现行社会医疗保险制度的绩效。在批判性评估的基础上，本文试图解决中国在走向全民覆盖的过程中面临的问题。文中特别针对泰国实施全民医保的改革经验，结合中国的具体情况，阐述了对中国进一步改革的政策启示：首先，应进一步缩小不同计划之间的福利方案差距；其次，需要改革现行的按服务收费制度；第三，需要加强初级医疗保健的提供和转诊制度，以配合医疗保险制度的改革；第四，提高风险分担水平和整合分散的保险计划应是改革的长期目标。(C)2011爱思唯尔有限公司。保留所有权利。
China is now in the course of implementing a new round of health system reforms. Universal health insurance coverage through the basic social medical insurance system is high on the reform agenda. This paper examines the performance of China's current social medical insurance system in terms of revenue collection, risk pooling, the benefit package, and provider payment mechanisms based on a literature review and publicly available data. On the basis of critical assessment, the paper attempts to address the issues challenging China as it moves towards universal coverage. Focusing in particular on the reform experience in Thailand as it implemented universal coverage, the following policy implications for further reform in China are articulated, taking into account China's particular circumstances: firstly, the gaps in the benefit package across different schemes should be further reduced; secondly, the prevailing fee-for-service payment system needs to be transformed; thirdly, the primary health care delivery and referral system needs to be strengthened in coordination with the reform of the health insurance system; and fourthly, raising the risk pooling level and integrating fragmented insurance schemes should be long-run objectives of reform. (C) 2011 Elsevier Ltd. All rights reserved.