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本文采用比较研究的方法,分析了中美儿童公共医疗保险体系在项目类型与资格条件、待遇标准、实施效果以及评估机制五个方面的差异。表明与美国相比,中国存在保险项目种类多而杂,制度可持续性待解;在初级保健和大病救助方面保障不足;评估体系没有对儿童群体进行单独评估等问题。以上问题导致中国儿童医疗保障水平落后于经济发展水平,不利于儿童的健康成长,因此儿童公共医疗保险体系改革已经迫在眉睫。必须完善保险项目的统筹衔接,增强制度的可持续性,着力于儿童的初级保健和大病救助,在评估体系中强调对儿童的单独评估。
In this paper, a comparative study is conducted to analyze the differences in the five aspects of the project’s type and eligibility criteria, treatment standards, implementation effect and evaluation mechanism between China and the United States children’s public health insurance system. This shows that China has many different types of insurance programs compared with the United States, the sustainability of the system to be solved, the lack of protection in primary health care and serious illness relief, and the lack of separate assessment of children groups in the assessment system. As a result, the level of medical insurance for children in China falls behind the level of economic development and is not conducive to the healthy growth of children. Therefore, the reform of children’s public medical insurance system is imminent. It is necessary to improve the cohesion of insurance programs, enhance the sustainability of the system, focus on the primary care and serious illness relief for children, and emphasize a separate assessment of children in the evaluation system.