【新闻背景】 [News background]

　　近年来，不少地市将城镇居民医保、新农合整合成一种制度，以放大医保的效用。

In recent years,Many cities will medical insurance for urban residents/New farmers close integration into a kind of system,To enlarge the effectiveness of medical insurance.

　　从全国来看，有一些地市如广东深圳、东莞，已把城镇职工医保、城镇居民医保、新农合整合为一种制度，待遇水平一样，对于参保者来说已不存在身份的区别。

nationally,There are some cities such as shenzhen, guangdong/The dongguan,Have medical insurance for urban workers/Medical insurance for urban residents/New farmers close integration is a kind of system,Treatment level as,For the participants, no longer exists identity difference.

　　那么，整合医保制度、消除参保身份不同带来的差异，是否已成为医疗保障体系发展的趋势呢？三种医保该不该整合、该怎样整合、制约因素又有哪些？

so,Integration medical insurance system/Eliminate the difference of different status ginseng bring,Whether medical security system has become the development trend of it?Three kinds of medical insurance should integration/How to integrate/What factors?

　　【核心观点】 [Core ideas]

　　观点一 Viewpoint a

　　医疗保障体系发展只能循序渐进，只有将差距逐步缩小后，才能用一个制度覆盖所有人

Medical security system development can only step by step,Only after the gap gradually reduce,To use a system covering all the people群。 group.

　　观点二 View two

　　目前未能迅速提升统筹层次的原因，主要还是城乡制度分割与管理部门分割，并非财力问题，各地医保基金有大量结余而非收不抵支。

At present failed to rapidly promote the cause of the level of overall planning,The main or urban and rural system division and management department division,Not financial problems,The medical insurance fund all have a large number of balance rather than close not to branch.

　　观点三 View three

　　医保不可能孤军突进，需要医疗卫生、医药体制改革紧密配合。

Medical insurance may not alone dart,Need medical and health/Medical system reform closely.

　　一问　医保为何有区别？ Ask why medical insurance have distinction?

　　记者：目前我国全民医保制度，推进到了哪一步？有人称存在碎片化现象，这怎么理解？

reporter:The medical insurance system in China at present,Push to which step?To be called phenomenon existing fragments,How to understand the?

　　郑功成：经过3年努力，全民医保的愿景正在变成现实。

ZhengGongCheng:After three years of hard work,Universal coverage vision is becoming a reality.

　　当然，全民医保并非是自动实现全民100%保险，也不等于全民免费医疗，因为我国选择的不是福利国家道路而是社会保险型制度，不参保、不承担缴费义务便不能享受相应的医保待遇。

Of course,Universal coverage is not automatic achieve the 100% insurance,Also not be equal to the free medical care,Because our country instead of welfare state road but social insurance type system,Don't ginseng/Do not assume capture to expend obligation cannot enjoy the corresponding medical insurance treatment.

　　所谓制度碎片化，就是应对同类风险的社保制度按不同人群进行分割的方式来实施。我国现行医保制度包括职工基本医疗保险、城镇居民基本医疗保险与新型农村合作医疗，再辅之以医疗救助，是典型的城乡分割、就业人口与非就业人口分割。其成因主要有三：

The so-called system fragmentized,Is similar to deal with the risk of social security system according to the different groups of segmentation way to implement.China's current medical insurance system includes the basic medical insurance/Urban resident basic medical insurance and the new rural cooperative medical care,Then supplemented by medical assistance,Is a typical urban and rural areas/Employment population and the employment demographic segmentation.The main causes are three:

　　一是城乡分割的路径依赖。改革前城镇是公费医疗与劳保医疗，农村是合作医疗，现在农村居民的医保虽再无合作成分却仍沿用过去叫法，并继续采取分割方式推进，这显然是旧体制的沿袭；

One is the urban and rural areas path dependence.Before the reform of town is medical treatment at public expenses and the labor protection medicare,The rural cooperation medical treatment,Now the rural residents' medical insurance is no cooperation composition still continue to use the past way,And continue to take way to separate the propulsion,This is obviously the old system follows;

　　二是渐进改革的路径依赖。我国的改革事业普遍采取先局部试点后逐步扩展的渐进策略，医保也不例外，先从职工医保改革开始，再陆续建立覆盖其他人口的医保制度，从而导致了城镇就业人口与非就业人口的分割；

The second is gradual reform path dependence.The reform of our country business generally adopted to local pilot spread gradually after the progressive strategy,Health care is no exception,From the worker first health-care reform began,Then been established cover other medical insurance system of the population,Leading to the town employment population and the employment population division;

　　三是各地自主试验，虽激发了地方的积极性与创新性，但因缺乏顶层设计，致使各地医保模式五花八门。

All three are independent test,Although inspired place enthusiasm and creativity,But due to lack of top design,All the medical insurance mode is multifarious.

　　吴明：碎片化现象与我国的发展状况有关，各地区之间、城乡之间经济发展不均衡，不同人群收入水平差距较大，这决定了我国在现阶段难以用一个制度、用统一的标准建立适合所有人群的医保制度。

Wu Ming:Debris phenomenon in our country and the development of the situation,Between various regions/Economic development imbalance between urban and rural areas,Different groups of income level difference is bigger,This determines the our country at the present stage is difficult to use a system/With unified standard to establish suitable for all the medical insurance system.

　　因此，我国的医疗保障体系发展只能循序渐进，逐步推进医保制度的统筹发展，最终实现制度的统一。也就是说，只有将这些差距逐步缩小后，才能用一个制度覆盖所有人群。

therefore,Our country's medical security system development can only step by step,Gradually promote the development of medical insurance system as a whole,Finally realize the unity of the system.That is,Only these gap reduced gradually,With a system to cover all the crowd.

　　目前我们国家的医保制度已经覆盖了全民，这一点确实很了不起，但保障水平还有待提高。

At present our country's medical insurance system has covered all the people,This is really amazing,But security level needs to be improved.

　　二问　没钱是统筹障碍？ 2 q have no money is as a whole disorder?

　　记者：医保整合分步走面临现实困境是什么？有些地方走得较快，如广东，是否与当地财力状况、人均支出水平高有关？

reporter:Health care integration step walk facing the real predicament is what?Some place to go faster,Such as guangdong,Whether with the local financial condition/The high level of per capita expenditure?

　　郑功成：我在2007年主持《中国社会保障改革与发展战略》研究时，曾邀请过多位专家研讨医保改革路径问题，提出三步走方案，即尽快将城乡分割的居民医保制度整合为统一的城乡居民医保，在条件成熟时再与职工医保整合为全民医保制度。同时，主张尽快从做实地市级医保统筹开始，在“十二五”期间向省级统筹迈进，最终实现全国统筹。

ZhengGongCheng:In 2007 I host[China's social security reform and development strategy]research,Invited too much expert discussion health-care reform path problem,Three-step scheme is put forward,That is as soon as possible the inhabitants of urban and rural areas medical insurance system for urban and rural residents integration of the unity of medical insurance,In the conditions are ripe to and worker health care for the integration of medical insurance system.At the same time,As soon as possible to do that from the municipal medical insurance as a whole start,in"1025"To plan as a whole at the provincial level during the forward,Finally realize the national plan as a whole.

　　目前未能迅速提升统筹层次的原因，主要还是城乡制度分割与管理部门分割，并非财力问题。

At present failed to rapidly promote the cause of the level of overall planning,The main or urban and rural system division and management department division,Not financial problems.

　　因为各地医保基金有大量结余而非收不抵支，2011年底全国职工医保基金累计结余已达5525.52亿元，新农合结余824.42亿元，城镇居民医保结余413.57亿元。

Because the medical insurance fund all have a large number of balance rather than close not to branch,By the end of 2011 the national worker medical insurance fund accumulated balance has reached 552.552 billion yuan,New farmers close balance is 82.442 billion yuan,Medical insurance for urban residents balance is 41.357 billion yuan.

　　况且，职工基本医保来自财政的补贴仅占3.47%，城乡居民医保中来自财政虽占82.09%，但中央财政负担了43.2%，而中央财政对中西部地区的投入更是占到80%以上。

besides,From the basic medical insurance financial subsidies accounted for only 3.47%,Urban and rural residents in the medical insurance from financial is 82.09%,But the central financial burden by 43.2%,And the central finance in the Midwest input is account for more than 80%.

　　从上述巨额基金结余和财力投入结构，以及西部地区也有医保城乡统筹与地市级统筹的成功实践，表明再以财力不足作为影响制度整合和统筹层次提升的理由并无依据。

From the above huge fund balance and financial resources invested in structure,And the western region has also have medical insurance in urban and rural areas as a whole and the successful practice of the prefecture-level cities as a whole,Shows that financial shortage as to affect system integration and overall level ascending reason and no basis.

　　我认为，关键还是没有统一的管理部门，无法采取步调统一的行动，从而是体制性或人为因素而非财力因素在阻滞。

I think,The key is to has no unified management department,Unable to take unified action pace,Thus is institutional or human factors rather than financial factors in block.

　　吴明：有些地方具备了条件，可以先行一步，比如广东东莞，已将三项制度合一。它的人口结构年轻，职工、城镇居民、农村居民等人群之间收入差距小，城乡之间几乎没有区别，当地居民收入水平相对较高，政府财力状况好，因此可以先行一步。

Wu Ming:Some places have conditions,Can one step ahead,Such as guangdong dongguan,Have one three systems.Its population structure young,worker/Urban residents/Rural residents income gap between people, such as small,Almost no difference between urban and rural areas,Local residents income level is relative taller,The government financial capacity, good,So it can be one step ahead.

　　当然，医保由不同的部门管理不仅增加了管理成本，也会影响到各项医保制度的统筹发展。但地区之间、城乡之间和不同人群之间的收入差异是影响制度整合中的主要因素。

Of course,Medical insurance by different department management not only increased management costs,Also can affect the overall development of the medical insurance system.But the region between/Between urban and rural areas and between different groups of the income difference is the main factors affect system integration.

　　三问　整合之后谁来管？ Three ask after integration who come to tube?

　　记者：三种医保制度归属不同部门管理，如果制度合一，哪个部门负责管理更加合适？有人提出应有一个高于部门的改革协调机构才能推动整合。您怎么看？

reporter:Three kinds of medical insurance system belong to different department management,If the system and,Which department is responsible for management more appropriate?Someone should have put forward a higher than the reform of department coordination mechanism to promote integration.How do you see?

　　郑功成：在卫生部门未与公立医院真正脱钩的条件下，归口人社部门统一管理全民医保应当是合适的选择。人社部门不仅具有长期管理医疗社会保险的机构、人员、经验积累与信息系统，而且和医疗方没有直接利害关系。

ZhengGongCheng:In the department of health not and public hospital really decoupling conditions,Centralized people club department unified management universal coverage should be the right choice.People club department not only has the long-term management of medical social insurance agencies/personnel/Experience accumulation and information system,And and medical party have no direct interest relationship.

　　卫生部门则宜切实负责公共卫生发展和推动公立医院改革，并构建布局合理、方便就医的医疗系统，同时参与全民医保的监督。

The department of health should earnestly is responsible for public health development and promote the public hospital reform,And building layout is reasonable/Convenient medical health system,At the same time to participate in the supervision of the universal coverage.

　　只有这样，才能消除部门利益，统一经办机制，并实现医保制度整合与医卫、医药等配套改革同步发展。

Only in this way,To eliminate the department interests,Unified handling mechanism,Medical insurance system and realize the integration and medical health/Medical reforms of synchronous development.

　　为此，确实需要有一个超越主管部门之上的权威协调机制，如赋予国务院医改办做好医改及其实践路径顶层设计的更大权责，在当前具有必要性。

therefore,Really need to have a competent department beyond authority over coordination mechanism,If give cure of the state council to do reform and practice path top design more responsibility,In the current has the necessity.

　　吴明：整合后的制度由哪个部门管理，应该由中央政府来决定。

Wu Ming:After the integration of the system by which the department management,Should the central government to decide.

　　从目前来看，卫生与人社管理各有优劣势。如果卫生部门管医保，属于“一手托两家”，需要同时考虑参保人和医院的利益，可以更有效的使用好医保资金。人社部门的优势是能够更好地发挥监督作用。

It seems,Health and people club management each have advantages and disadvantages.If the health department tube medical insurance,Belong to"On hand to two",Need considering ginseng to protect the interests of the people and the hospital,Can be more effective use of good medical insurance fund.People club department's advantage is to better play to the supervisory role.

　　记者：医保制度的整合是可以单兵突进，还是必须多种改革联动进行？

reporter:The integration of medical insurance system is to be able to solo dart,Or must be a variety of reform on linkage?

　　郑功成：医保不可能孤军突进，而是需要医疗卫生、医药体制改革紧密配合，这是以往实践证明了的基本结论。

ZhengGongCheng:Medical insurance may not alone dart,But need to medical and health/Medical system reform closely,This is in the past practice proved that the basic conclusion.

　　因此，必须通过公立医院的改革来切断医药之间的利益链条，实现管办分离、医药分离并确保其公益性，同时扶持社会或民营医疗机构发展，使之在相互竞争中不断提升服务质量。同时，公共卫生充当着全民医保的基础，医药系统肩负着药物供应的使命，它们都直接影响着全民医保的实践效果，从而必须同步推进改革。

therefore,Must be through the reform of public hospital to cut off medicine between benefit chain,Realize tube do separation/Medicine separation and make sure that the public welfare,At the same time support social or private medical institutions development,Make in competition with each other continuously improve the service quality.At the same time,Public health as the basis of the universal coverage,Medical system shoulder the mission of drug supply,They are directly affects the effect of the practice of the universal coverage,That must be synchronized advancement reform.

　　此外，医保信息化建设也是一项基础性工程，必须尽快改变多头经办格局下信息系统相互分割的状况，在统一经办的同时推进统一的医保信息化建设，这是解决重复参保、资源浪费等问题并实现有效监管的必要技术保障。

In addition,Medical insurance information construction is also a basic project,Must change as soon as possible long handling pattern information system mutual integral status,In unity and the unity of orgnaization of promoting medical insurance information construction,This is repeated ginseng to solve/Problems such as the waste of resources and realize the effective supervision is necessary technical support.

　　吴明：医保支付方式改革是公立医院改革最核心的改革环节之一，它能够有效的激励和约束医疗服务提供者，并推动医疗服务体系的改革。

Wu Ming:Medical insurance payment reform is the core of the reform of public hospitals reform one of the link,It can effective incentive and restraint medical service provider,And promote the reform of the medical service system.

　　应统筹、协调地推进医疗服务体系和医疗保障体系的改革。医保支付制度改革要与临床路径、医疗质量监控和医生的收入分配制度改革同步推进，这样可以鼓励医生提供优质、合理的服务。在规范医务人员行为的同时，也充分调动了他们提供服务的积极性。 李红梅

Should plan as a whole/Coordinate to promote medical service system and the reform of the medical security system.Medical insurance payment system reform with the clinical pathway/Medical quality monitoring and the doctor's reform of the income distribution system synchronized advancement,So we can encourage doctors to provide quality/Reasonable service.In the standardization of medical staff behavior at the same time,Also give full play to their enthusiasm to provide services. LiGongMei