中国8 省农户的医疗保障制度与健康风险管理分析 －－“健康风险对中国农村地区家庭收入与消费的影响研究”课题报告之二.docVIP

中国8省农户的医疗保障制度与健康风险管理分析 －－“健康风险对中国农村地区家庭收入与消费的影响研究”课题报告之二 高梦滔 海闻 姚洋 北京大学卫生政策与管理研究中心 No. C2003003 2003年10月29日 中国8省农户的医疗保障制度与健康风险管理分析 －－“健康风险对中国农村地区家庭收入与消费的影响研究”课题报告之二 高梦滔，海闻，姚洋 The 8 provinces rural households health care insurance and health risk management : the 2nd report of the subject The impact of health risk on household income and consumption in rural area china. By and Gao Mengtao，Hai Wen and YaoYang 关键词：健康保险，风险分担，非正式风险应付，新型合作医疗，中国 Key words: Health insurance, risk pooling, informal risk coping, The new RCMS, China 摘要 本专题报告主要集中于样本人群的医疗保障制度覆盖情况和农村非正式的健康风险管理办法。主要的分析结果在于：1. 中国农村居民健康保障制度覆盖率较低。在样本中，农户医疗保障覆盖率仅为6.48%；2. 和亚洲几个国家相比较，中国在医疗支出中患者现费支付的比例处于较高的水平；3. 在农村地区尤其是发达的农村地区商业医疗保险占的份额逐步提高。但是商业医疗保险普及的现阶段主要困难在于交纳的保费太高，贫困地区的农户难以承受。现阶段农村并行的两种医疗保障制度实际上其执行的功能各异。设想现阶段在中国农村可以实行医疗保障制度的“双轨制”，即：第一在贫困农村地区主要实行新型的合作医疗制度，但主要定位于提高日常医疗保健服务的可及性与可得性；第二着重鼓励富裕地区新兴的商业医疗保险，承认市场自发的力量和农户的理性选择。 在新型合作医疗的推广中，管理是关键。从课题分析结果来看，如果对管理方面没有整套行之有效制度与规章的话，难免重蹈“春办秋黄”的覆辙。 Abstract This report focuses in the health insurance coverage transformation and informal health risk coping strategy from 1987 to 2002 in rural area China. The output lies in the following findings: 1.the rural household have low health insurance coverage, in our sample, the health insurance coverage is only 6.48%; 2.compared with the other countries, the rate by using fee for health service is higher; 3.in rural area, especially in advanced area, the private health insurance coverage rate has increased. But it is difficult to enhance the private health insurance coverage; the main problem is the premium is so high, the poor cannot afford at this stage. Today the private health insurance and RCMS(rural cooperative health system)play different roles in rural area, assuming 2-tier insurance system are practiced .In the poor area, the new RCMS could enhance the seeking for health service on common disease and in the advanced area to encourage the private health insurance that is a rational choice for household health risk cop