Abstract: Currently, a high percentage of China’s households still face financial catastrophe as a direct result of having to pay for health care through out-of-pocket. To design a financing system for reducing catastrophic health expenditure, the present paper constructs four interactive models for critical illness insurance based on the reinsurance and coinsurance approaches in the context of China's New Urbanization Plan. Besides, the mechanisms are empirically simulated with data of China Family Panel Studies (2012). Our findings show that four interactive mechanisms could alleviate the incidence and severity of catastrophic health expenditure, especially the incidence of models Ⅲ could be reduced to 0.55%, which fully meet the mechanism goal.

摘要： 目前，我国住院病人个人自付费用占医疗总支出的比例较高，城乡居民面临着家庭灾难性医疗支出的威胁。本文依据社会基本医疗保险按次报销和大病保险按年度累计补偿的不同特征，设计了“再保险”、“共同保险”、“再保险之上共同保险”、“共同保险之上再保险”四种模式，以期完善我国城乡居民大病保险。进一步地，本文以“个人自付比例占医疗费用总支出的20%左右”、“避免家庭灾难性医疗支出”为制度设计目标，测算不同模式下大病保险的起付线、封顶线与补偿比例。最后，本文采用2012年中国家庭追踪调查（CFPS）数据模拟测算后发现，前述四种模式均能有效降低城乡居民灾难性医疗支出的发生概率和严重程度。其中，“再保险之上共同保险”模式可将灾难性医疗支出的发生概率降至0.55%，满足大病保险的设计预期。