【作者】 施劲华；

【导师】 夏永祥；

【作者基本信息】 苏州大学 ， 财政学， 2012， 博士

【副题名】基于“税收杠杆”与“三医联动”双重作用的模式设计

【摘要】 “看病贵、看病难”问题的凸显以及医改新政实施的如火如荼，使得我国的医药卫生问题成为社会发展中的焦点。国外医疗模式多样，而中国的实际国情却呼唤有中国特色的医疗卫生发展模式。笔者创造性提出“分层次医疗体系”新模式，提出了将医疗服务划分为温饱型、小康型、奢侈型三个层次，政府应当为广大农村和低收入城市群体提供免费的温饱型的医疗保障，保障其基本生存问题。在温饱型的基础上大力发展小康型医疗服务，即在保证生存权的基础上，讲求医疗服务的质量，提高生活质量。而奢侈型医疗保障服务主要是针对社会高收入群体提供高水平的医疗技术服务和药物治疗，政府收取奢侈消费税收，用奢侈消费税收来弥补温饱型消费市场的政府投入，从而让更多的资金来支持温饱型的医疗服务。笔者认为，要在我国推行分层次医疗保障体系模式，需要实行“穷人医疗、富人买单”式的调剂。其基本思路是，通过小康型、奢侈型医疗服务收取的消费税和奢侈税，为温饱型医疗服务提供资金保障，从而实现“抽肥补瘦”式的“穷人医疗、富人买单”。具体的手段则是通过税收的杠杆作用来实现这种调节。为保证“分层次医疗体系”模式的顺利执行，笔者还提出应设立“全民医疗保障税收调剂基金”的构想。保障基金主要是针对广大低收入和贫穷人群建立，主要保障这类人群基本的生存权，做到“老有所医、病有所医”，所有的温饱型医疗消费都应该是免费的。而小康型是建立在温饱型消费基础之上，包含部分温饱型医疗保障的项目，依照就医者的实力，需要提供更好治疗的医疗服务，可以采取部分高水平和质量的医药、治疗项目，进行适当地征收消费税；而奢侈型医疗只包含基本的医疗基金补贴，大部分医疗费用应该由患者自付，并征收较高的奢侈税，在整个国家和社会范围内实现医疗保险“风险分担、互助共济”的重要功能，这是实现基本免费医疗的重要基石，也是本文试图论证的最重要的观点。更多还原

【Abstract】 The issue of "Seeing a doctor is difficult, seeing a doctor is expensive" and the NewDeal of the health reform implementation in full swing, China’s medical and health issuesbecome the focus of social development. The foreign medical model of diversity, whileChina’s actual conditions, but calls for health development model with Chinesecharacteristics. The author creatively put forward a new model of hierarchical health caresystem, the Government should provide free health care protection of subsistence for themajority of rural and low-income urban groups. On the basis of the subsistence vigorouslydevelop the well-off medical services that ensure the basis of the right to life, emphasis onthe quality of medical services to improve the quality of life. Luxury type of medicalinsurance services mainly to provide a high level of medical services and medication forsocial high-income groups, government collection luxury consumption tax, luxuryconsumption tax to make up for government investment of the subsistence of the consumermarket, so that more funds to support the subsistence of medical services.The author believes that the implementation of the sub-level medical security systemin China, need the implementation of "poor medical care, the rich pay".The basic idea isthat, by the well-off luxury medical services received by the consumption tax and luxurytax to provide funding for the subsistence of medical services, in order to achieve apumping manure to fill skinny "poor medical, the rich pay". The specific means to achievethis regulation is the leverage of tax.In order to ensure the smooth implementation of the hierarchical health care systemmode, I also put forward the concept of" universal health care tax swap fund “. SecurityFund is established for the majority of low-income and poor populations, mainly to protectthis population’s right to live, so that all food and clothing for health care spending shouldbe free. Well-off is the basis of food and clothing consumption, contains part of the subsistence medical protection project, in accordance with the strength of medicaltreatment, medical services need to provide better treatment, you can take some of the highlevel and quality of medicine, treatment programs, appropriate levy of consumption tax;luxury medical contains only basic medical fund subsidies, the majority of medicalexpenses by the patient pays the luxury tax and impose a higher health insurancerisk-sharing throughout the state and society within aims at treating an importantfunction, which is to achieve an important cornerstone of the basic free medical care, thisarticle attempts to demonstrate the most important point.更多还原