中国医疗保障发展报告（2023）
中文摘要
《中国医疗保障发展报告（2023）》以中国多层次医疗保障体系的建设为主题，在厘清一些认识误区的基础上，全面系统地回顾和分析了我国多层次医疗保障体系建设的主要成就、现存问题与当前挑战，并展望了该体系未来的改革与发展趋势。报告涵盖了对多层次医疗保障体系发展的总体评估，以及对职工基本医疗保险制度、居民基本医疗保险制度、商业健康保险、职业性医疗福利、慈善医疗发展情况的分析，同时客观反映了陕西省、四川凉山彝族自治州、广东佛山市和中山市多层次医疗保障体系的发展建设情况，以及人保公司健康保险专业化经营、北京市惠民保发展、水滴公司参与多层次医疗保障制度体系建设等案例。
报告指出，基于中国式现代化和走向共同富裕的国家目标对健全的医疗保障制度的迫切要求，现阶段是最需要建立多层次医疗保障体系并充分发挥其作用的时期。只有在全面深化改革中加紧推进多层次医疗保障体系建设，才能更好地满足不同社会阶层人群的保障需求，并在彻底切断贫病之间链条、真正化解人民群众疾病医疗后顾之忧的基础上助力全体人民走向共同富裕。
报告指出，基于责任主体及运行机制的不同，可以将多层次医疗保障体系确定为三个层次，即政府主导的法定医疗保障、市场主导的商业健康保险及相关保障、社会力量支撑的慈善医疗。中国多层次医疗保障体系在实践中得到了较快发展，特别是法定医疗保障的功能在明显增强，商业健康保险与慈善医疗都在发展，但当前的局面仍然只是呈现出了多层次的轮廓而不能称之为体系化，每个层次的保障均很难分别解决其应当解决的现实问题，更未形成一个有序衔接的整体，其综合效能也因之打了折扣。概括而言，法定医疗保障制度仍未成熟，居民医保制度更是存在缺陷，商业健康保险发展滞后，慈善医疗未能有效对接，不同层次医疗保障制度之间缺乏有序衔接且存在功能紊乱现象，致使疾病医疗仍是城乡居民的后顾之忧。
报告建议，中国建构多层次医疗保障体系应当始终以不断完善、健全法定医疗保障制度为出发点与归宿。在此前提下，必须厘清不同层次制度安排的功能定位和轻重缓急。在法定医疗保障层次，应当充分发挥有为政府的作用，为全体人民提供清晰、稳定的医疗保障预期；在商业健康保险层次，应充分发挥有效市场的功能，满足有需要者的需要；在慈善医疗层次，则应尽展社会向善的力量，助力兜住疾病医疗保障的底线。
报告建议，在多层次医疗保障体系建构中，依据功能定位厘清不同层次制度安排的地位与作用，在政策上分清轻重缓急精准施策，在实践中厘清主次分类推进。总体政策取向应当是加快优化法定医疗保险制度并使之定型，同时精准支持商业健康保险，有效对接慈善医疗，最终以法定医保制度主导的多层次医保体系来满足全体人民的多层次医保需要，进而向健康中国稳步迈进。
报告建议，应当创造有利于多层次医疗保障体系建设与发展的配套条件。公共卫生作为关系人民群众健康的基础性工程，需要对其继续给予高度重视并扎实推进其健康发展。在医疗服务方面，医疗卫生资源的合理布局和公立医院真正公益化是关键。针对药品与医用耗材定价失控、流通失范的现象，既要发挥好医疗保障机构战略购买者的作用，也要进一步健全药品与医用耗材市场竞争规则。
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总报告
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专题篇
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案例篇
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