日本公共医疗保险制度的互助共济机制

在世界上老年人口抚养比较高的国家之中,日本公共医疗保险制度的医药费支出占GDP的比例相对较低。本文详尽地介绍日本独特的、完整成熟的跨年龄、地区和职业的医保互助机制及其背景和理念。因职业、年龄等不同,每个人所参保的制度不同,但是在待遇方面,所有的制度对于医药服务的种类和报销政策都相同。患者可以在任何时候、选择任何医院就诊。筹资模式因制度不同而不同,当一个制度所覆盖的群体主要是低收入者时,政府用财政的一般预算收入来资助。由于年龄分布不同所造成的各个制度的医药费支出负担的不同,本着公平的原则进行了调整。调整了年龄差距之后的人均医药费支出总额相同的话,不管在哪个地区,收入相同的人应当缴纳相同数额的保费。

Cost Sharing among Different Ages/Regions/Occupations in Japanese Social Security Healthcare

Among maj or countries with the highest old-age dependency ratio,Japan’s annual medical expenses of social security healthcare as a ratio to GDP are relatively low.This paper presents the unique Japanese full-fledged cost-sharing mechanism of medical expenses across different ages,regions and occupations,and its background and philosophies.Five separate social security healthcare systems cover different population groups by age and occupation,but benefit policies are the same,and every patient enjoys free access to any medical service provider at any time.The financing methods differ across healthcare schemes.Schemes mainly covering low-income persons receive statutory transfers from general government revenue.Differences in medical costs due to different age distribution in different schemes are adjusted in line with the principle of equity.Persons with the same income level should pay the same amount of contributions regardless of region,provided that the age-adjusted medical costs per person remain the same.