中國城鎮醫療保險制度改革及其發展之研究

Research on the reform and development of Social medical Insurance in Urban China

楊仲源(Chung-Yuan Yang)

指導教授 ： 洪鎌德

國立臺灣大學/社會科學院/國家發展研究所/博士(2008年)

https://doi.org/10.6342/NTU.2008.00668

摘要

本文探討1950年中國建國之後，中國城鎮地區社會醫療保險制度（早期由於是中央政府總攬，被稱為醫療保障）的演變。早期由於醫療服務制度是免費醫療（Free for healthcare） ，企業與政府的職工都認為單位（Unit）提供醫療服務乃是天經地義的事，即是公費醫療與勞保醫療制度。
文革之後，經濟對內改革對外開放，由於企業經市場機制的引進。而充滿活力，在1989年之前由於國家致力經濟發展，人民的醫療權益遭到漠視。形成醫療体制遭「解構」的情況。
1992年鄧小平南巡，經濟續推展，十四大後「社會主義市場經濟」建立，1994年底，中央政府熱衷對用市場化方式「重建」醫療系統及醫療保險。除了推動「兩江」模式，1996全國試點，到1998年正式試點，僅有五年時間。在倉促的情況下，仿德國與新加坡，建立「統帳模式」醫療保險。其中醫療儲蓄帳戶（Madical saving account）與先進國家流行的社會保險模式不同，MSA主要在新、美、中國等地實施。社會統籌帳戶類似西方社會保險。
然而此舉忽略了醫療行業，雖亦可市場化，但以中國社會主義之背景醫療為具有公益性質的產業，以市場化手段來推動醫療保險及醫療服務，對弱勢民眾（下崗、失業、農民工等……）勢必不利，乃引起學界爭論。
在2005年國務院承認醫改失敗，但未來採何種「模式」才適合中國國情，此部分，尚無答案。多數學者認為「國家」的角色應該重新引入，無論在社會醫療保險或者醫療衛生服務，政府在財政、制度設計資源規劃等，重建其應當該承擔之角色乃刻不容緩之要務。

關鍵字

社會醫療保險 ； 醫療保險 ； 中國 ； 城鎮 ； 城市

並列摘要

Abstract
This Distertation introduces the development of medical social insurance in urban China since 1950. Most people think the healthcare service is free provided by government. The employees of enterprises and civil service workers believe their “Units” should pay the fee for healthcare.
When the ecomics reform era comes , the market mechanism is introduced. Because the government emphases that economical development is most important in all policy, people’s rights to keep health（to go to hospital for healthcare） is ignored. Healthcare treatment system has been destruct.
After the CCP leader Deng Xiao-Ping continues to push forward economy in 1992 ,the “market-orinted Socialism ” is established. Central government feels interested to resconstruct the Healthcare institution and health financial resource by the force of marketplace. Under the circumstances, the Two-Jiang Model is advanced in 1994. Next, this policy carries out to 57 cities. Finally , Central government declares new policy have to implement to all Chinese urban areas in 1998.
In short time, the new (medical insurance )model combines “Social poling Fund” and “Madical savings account” is found. As Chinese scholars indicate , “Social Poling Fund imitates German social health insurance and “Madical savings account” learns the Central Public Fund from Singapore. The operation of new mixed social medical insurance is totally different from the Western “Welfare State” model. It insists that healthcare service should not be financed by government. Everybody has to be responsible for the fee of healthcare service.
This policy is not supported by public opinions. Most people suppose healthcare expenditure should be paid by public finance but not personal pocket. Medical science is specialized subject which should’nt regard as common knowledge. There is asymmetric information between medical experts and ordinary persons. “Madical savings account” causes unequal access to the rich and the poor . Urban residents with lower income can’nt afford enough money to healthcare service more and more expensive. High-priced healthcare spending becomes a serious social problem which is always criticized by the public voice.
The State’s Council admits that the reform policy of social medical insurance is
unsuccessful in 2005. Many specialists propose to reconstruc the role of the state is more significant in healthcare expenditure. The state should be more active in public finance to social medical insurance. And it is crucial function of the state to design effective and reasonable distribution of healthcare resources. The governmental duty can’t be replace by the Marketplace in healthcare service.

並列關鍵字

Social medical Insurance ； medical Insurance ； China ； Urban China ； Reform

參考文獻

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利菊秀、劉純之1995＜個人醫療儲蓄帳戶－政策與理論的發展＞，《風險管理學報》，1-22。

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