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选取广东省三个代表性地区的大规模医疗保险数据,对职工医保分散大病风险的效果进行了定量分析和模拟测算。从总体上看,参保人的医疗负担还比较重;职工医保在缓解灾难性支出方面作用明显,但整体效果有限。在40%的门槛下,欠发达地区灾难性支出发生率达到29.3%,发达地区也达到了8.5%。相对弱势的中老年群体和低收入群体是灾难性支出发生率最高的群体,但并未受到职工医保的充分照顾。相反,20-39岁的年青群体和高收入阶层成为相对受益最大的群体。从保障水平调整机制、补充医疗保障体系以及医疗救助与职工医保的衔接等三个方面提出了政策建议。
The data of large-scale medical insurance in three representative areas of Guangdong Province were selected to quantitatively analyze and simulate the effect of the risk of the serious illness of medical insurance for employees. Overall, the medical burden on insured persons is still relatively high. The employee health insurance plays a significant role in alleviating catastrophic expenditure, but the overall effect is limited. Under the threshold of 40%, the incidence of catastrophic disbursements in underdeveloped areas reached 29.3% and in developed areas reached 8.5%. The relatively disadvantaged middle-aged and elderly groups and low-income groups are the groups with the highest incidence of catastrophic disbursements, but they are not adequately cared for by employee health insurance. In contrast, young people and high-income earners aged 20-39 are among the relatively more beneficiaries. Policy recommendations are put forward in three aspects: the mechanism of adjusting the level of protection, the system of supplementing medical insurance, and the interface between medical aid and employee medical insurance.