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第一章多层次医疗保障体系的发展历程

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所属报告：

艾社康：2021-2022多层次医疗保障创新案例集（61页）.pdf

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民医保体系的初步建立，使得人民群众看病就医有了基本保障，但由于各种补充医疗保险、商业健康保险等发展刚刚起步，保障的作用非常有限，作为主体的基本医疗保障筹资也处于较低水平，医疗费用的快速上涨使得人民群众对大病医疗费用负担重的反映普遍比较强烈。在此背景下，为了进一步完善城乡居民医疗保障制度，健全多层次医疗保障体系，有效提高重特大疾病保障水平，城乡居民大病保险作为对大病患者发生的高额医疗费用给予进一步保障的一项制度性安排被提了出来。2012年，开始在全国范围内探索城乡居民大病保险，作为基本医疗保障制度的拓展和延伸，目的是要切实解决人民群众因病致贫、因病返贫的突出问题。同年，民政部、财政部、人力资源和社会保障部、卫生部联合发布《关于开展重特大疾病医疗救助试点工作的意见》（民发〔2012】21号），在开展常规医疗救助的同时，启动重特大疾病医疗救助试点工作，以解决困难群众面临的重特大疾病问题。2015年，国务院办公厅转发民政部等五部门《关于进一步完善医疗救助制度全面开展重特大疾病医疗救助工作的意见》，要求对城市医疗救助制度和农村医疗救助制度实施合并，全庭中的老年人、未成年人、重度残疾人、重病患者和因病致贫家庭重病患者等"。在这项具有一定顶层设计作用的政策文件中，医疗救助的实践经验得到了深化和固化，其作为多层次医疗保障体系中的托底性制度定位也得到了进一步的明确。在医疗救助的作用逐步强化的过程中，慈善捐赠也作为对医疗救助的一种补充，逐渐进入政府鼓励的视野。 2013年，民政部印发《关于加强医疗救助与慈善事业衔接的指导意见》，提出要使慈善事业成为“医疗救助的重要补充”。2014年，国务院在《关于促进慈善事业健康发展的指导意见》中明确要让“慈善事业对社会救助体系形成有力补充，成为全面建成小康社会的重要力量”。各类社会机构通过开展慈善义诊、药品援助、特定疾病患者援助等多种多样的慈善活动，为老年人、妇女、儿童以及多种罹患罕见病等重特大疾病的人群提供了补充的保障。与此同时，作为多层次医疗保障体系中重要的补充保障制度，商业健康保险也在2012年之后开始进入了发展的“快车道”，保费规模从 862.8亿元增长至2021年的8447亿元，年复合增长率达到25.6%。 2016年，国务院发文决定对城镇居民基本医疗保险制度和新型农村合作医疗制度进行整合，建立统一的城乡居民基本医疗保险制度「。我国的基本医疗保险制度在人群公平性上得到了显著的提高，原本城乡三项基本医保制度碎片化的问题也在一定程度上得到缓解。

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