社会医疗保险的真实保障水平研究——兼论“保障水平幻觉”

文章利用广东省样本地区医疗保险库的数据分析表明,社会医疗保险的实际保障水平偏低,现有制度未能从根本上解决居民看病负担较重的问题。名义保障水平与真实保障水平差距很大,存在"保障水平幻觉",导致"看病贵"问题被淡化甚至被掩盖,影响到保障水平的合理调整和制度目标的实现。实际补偿比作为真实保障水平的核心测度指标,应当成为政策调整的重要参照变量,在社会医疗保险改革过程中获得更多的关注。

A Study on Real Security Level of the Social Health Insurance:Exploring the Illusion of Security Level

Applying the data from the database of health insurance of the sampled cities in Guangdong province,the paper reveals that the security level of the social health insurance is too low to cover citizen’ s health risks.There exists an obvious gap between the nominal and the real security level,which is named "the illusion of security level" by the author.The problem of the high cost of getting medical service is ignored or is concealed to some extent and it affects the reasonable adjustment of the security level.The indicator of real rate of reimbursement,which acts as the key measure tool of the real security level,should become an important reference for the adjustments of the health insurance policies and deserves more attentions during the process of the reform of the social health insurance systems.