通讯作者: 王延中, wangyanzhong01@163.com

DOI：10.12201/bmr.202110.00038

Analysis on the Influencing Factors of the Reimbursement Effects of Critical Illness Insurance for Urban and Rural Residents from the Perspective of New Institutionalism

• 摘要：新制度主义认为，制度因素是影响参与者的行为选择，并进而导致不同结果的重要变量。基于这一视角，当前城乡居民大病保险制度的运行和保障效果不尽理想，首先应当从其制度框架方面寻找原因和影响因素。大病保险制度缺乏清晰明确的制度定位导致了一定的执行偏差，对关键概念的化用不利于充足保障和精准保障目标的实现，“类保险化”的补偿政策限制了大病保险的作用空间，筹资机制难以满足保障需要则直接导致了补偿不足。基于制度框架的不足因此，要更好解决城乡居民的大病保障问题，需要对当前原有的城乡居民大病保险制度进行根本性重构。在近期，基于不同人群的保障需求，建立起囊括基本医保、医疗救助和补充医疗保险等多种保障形式的综合性的大病保障制度体系。在中长期，当基本医保对大额医疗费用的实际补偿水平达到70%以上时，在基本医保制度中建立个人自付费用封顶机制，从根本上解决大病保障问题。

  关键词： 新制度主义，城乡居民大病保险，保障效果，影响因素

   

  Abstract: New Institutionalism believes that institutional factors are important variables that could influence the behavioral choices of participants and lead to different results. From this perspective, we couldshould look for the reasons and influencing factors of the unsatisfied operational and reimbursement effects of the Critical Illness Insurance for urban and rural residents from itsthe institutional framework first. The lack of clear system positioning of the Critical Illness Insurance System has led to certain implementation deviations. The misuse of key concepts hinders the realization of accurate protection and adequate reimbursement. The design of quasi-insurance reimbursement policies limits the reimbursement space of Critical Illness Insurance. The inability of the financing mechanism to meet the guarantee needs directly leads to insufficient reimbursement. Due to the limits of institutional framework,Therefore, to solve the critical illness protection problem of urban and rural residents better, it is necessary to carry out a fundamental rebuilding of the institutional framework of the Critical Illness Insurance System. In the short term, a comprehensive critical illness security system should be built covering fundamental medical insurance, medical assistance and supplementary medical insurance based on the different needs of different population groups. In the medium and long term, when the actual reimbursement level of fundamental medical insurance reaches 70% or even higher, introduce capping mechanism for individual out-of-pocket payment and solve the critical illness protection problem thoroughly.

  Key words: New Institutionalism, Critical Illness Insurance for Urban and Rural Residents, reimbursement effects, influencing factors

  提交时间：2021-12-21

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2021-10-13	bmr.202110.00038V1	下载

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