中国通向综合的医疗保险体系之路

PublicDisclosureAuthorizedPublicDisclosureAuthorizedPublicDisclosureAuthorizedPublicDisclosureAuthorized©2010TheInternationalBankforReconstructionandDevelopment/TheWorldBank1818HStreet,NWWashingtonDC20433USATel.+[phone]Internet:‘songoinghealthcarereform.TheseriesispublishedbytheWorldBankincollaborationwiththeGovernmentofChina.Thepaperstrackandanalyzethereformprocess,andevaluateearlyresults.Eachpaperfocusesonakeychallengethatiscentraltosuccess.Thepapersarewrittenfromapragmaticperspective—namely,howthereformscanberefinedandimprovedastheprocessunfoldsoverthecoming5to10years.Experienceisreportedinthecontextofinternationalbestpractice.ResearchwascarriedoutundertheWorldBank‘sAnalyticandAdvisoryAssistanceprogram,aparticularlyfruitfulcollaborationbetweentheBankandtheGovernmentthathasbeenunderwaysince2003.Initialtechnicalpaperspreparedbyteamsofnationalandinternationalexperts.PreliminaryversionswerecriticallydiscussedwithChinesepolicymakersandtechnicalcounterparts,especiallywithintheministriesthatinitiallyrequestedthisassistanceinmid-2008.Allpaperswerethensubjecttoarigorousprocessofpeerreview.ThepurposeofChinaHealthPolicyNotesistosharethesefindingswithabroaderaudience,especiallytoChinesepolicymakers,healthspecialists,andscholars.HardcopyversionsofthesepaperscanbeobtainedinEnglishandChinesebywritingtotheWorldBank.Theycanbedownloadedwithoutchargeat([e-mail]).TheBankwishestowarmlythankourmanycolleaguesandcounterpartsinChina,especiallyintheMinistryofHealth,theNationalDevelopmentReformCommission,theMinistryofHumanResourcesandSocialSecurity,theMinistryofFinance,andtheMinistryofCivilAffairs.WealsoextendgratefulappreciationtotheUKDepartmentforInternationalDevelopment(DfID),whichprovidedgrantsupportforAAAworkendingSpring2008.Opinionsexpressedinthesepapersareentirelythoseoftheauthors.TheydonotrepresentofficialviewsoftheExecutiveDirectorsoftheWorldBank,theUKDepartmentofInternationalAffairs,ortheGovernmentofChina.THEWORLDBANKHealth,Population,andNutritionEastAsiaandPacificRegionThePathtoIntegratedInsuranceSystemsinChinaJune2010CHINAHEALTHPOLICYNOTES3ThePathtoIntegratedInsuranceSystemsinChinaiiiTableofContentsAcronyms,abbreviations,currency..............................................................................................iiiExecutiveSummary...........................................................................................................................vii1.Introduction........................................................................................................................................12.DevelopmentoftheMedicalInsuranceSysteminChina.....................................................3Medicalinsuranceduringtheplannedeconomy..............................................................................3ExplorationoftheNewHealthSecuritySystem............................................................................4Enrollmentinurbanareas...................................................................................................................4NewRuralCooperativeMedicalInsurance......................................................................................63.UniversalMedicalInsurance........................................................................................................7UrbanEmployeeBasicMedicalInsurance(UEBMI)...................................................................7UrbanResidentBasicMedicalInsurance(URBMI).................................................................18NewRuralCooperativeMedicalInsurance(NRCMI).............................................................214.UEBMIandURBMI:AComparativeAssessment..............................................................27Individualfinancialburdens..............................................................................................................27Equityinaccesstoandutilizationofhealthservices..................................................................29Costcontainment...............................................................................................................................30Enrolleesatisfactionandutilizationofservices...........................................................................32Useofmedicalinsurancefunds......................................................................................................33Assessingthesystemincomparativeperspective........................................................................345.ComparisonofChina’sMedicalInsuranceSystemwithOECDCountries....................37OECDcountrymodels..............................................................................................