1980年代以来美国店主提供式医保(ESI)覆盖率下滑的原因.pdf

1980 年代以来美国雇主提供式医保（ESI）覆盖率下滑的原因 中文摘要 1980 年代以来美国雇主提供式医保（ESI ） 覆盖率下滑的原因 中文摘要 雇主提供式医保（ESI）是美国人获得医疗保险的最主要途径。它的产生与 20 世纪上半叶美国医疗服务的供需状况、医疗保险产业的发展、联邦政府的政策法规密 切相关。20 世纪80 年代以来ESI 覆盖率持续下滑的原因，主要包括医疗费用膨胀迫 使企业削减ESI 开支、ESI 税收优惠政策不公平和降低劳动力流动性的缺陷致使支持 率下滑、公共医保项目扩张排挤ESI 三个方面。为了阻止ESI 覆盖率的下滑，扩大医 保覆盖面，美国部分州政府和联邦政府在医改尝试中屡次采取雇主强制策略。本文拟 从ESI 的起源和发展入手，重点分析20 世纪80 年代以来ESI 覆盖率下滑的主要原因， 并总结美国政府应对ESI 覆盖率下滑的措施。本文的探析不仅有助于了解美国医疗保 险体系的历史和发展动态，也可以对当前我国城镇职工基本医疗保险制度的改革提供 某些借鉴。 关键词：美国；雇主提供式医保；社会保障；企业福利 作 者：陈 超 指导老师：高芳英 教授 I 英文摘要 1980 年代以来美国雇主提供式医保（ESI）覆盖率下滑的原因 The Reason for Decline in Coverage Rates of US’s Employer- sponsored Health Insurance from 1980s to Present Abstract Employer-sponsored Health Insurance(ESI) is the most important source of health insurance for Americans.The growth of ESI in United States was closely related to the supply and demand condition of medical services and the rapid growth of the health insurance industry during the first half of the 20th century. But the most important reason for the strong link between health benefits and the workplace were the federal government’ s price control and labor policies and tax laws during the World War II .However, from 1980s to Present , the coverage rates of ESI decreased 12.4%.There are many reasons for this steep drop. Firstly, as health care costs increase, it becomes increasingly difficult for employers to purchase health plan, more and more employers are cutting down expenses for ESI. Secondly, ESI’s internal flaws , the unfairly tax