绵阳市整合城乡居民基本医疗保险制度的研究

发布时间：2018-01-10 03:08

本文关键词：绵阳市整合城乡居民基本医疗保险制度的研究　出处：《西南科技大学》2017年硕士论文　论文类型：学位论文

【摘要】：我国已经建成了以城镇职工基本医疗保险制度、新型农村合作医疗、城镇居民基本医疗制度和城乡医疗救助制度为主体的具有中国特色的基本医疗保障体系,覆盖人数超过了13亿人口,全民医保体系已基本形成。然而随着社会的深入发展,这种城乡二元制户籍下形成的城乡二元化的医疗保障制度的弊端也日益显现出来,主要表现在缺乏社会公平性、不利于人力资源的流动、不利于医疗保险制度的可持续发展,同时造成了财政部门进行的重复财政补贴、城乡居民的重复参保现象、相关部门重复的建立信息系统和经办机构等系列问题。解决这一系列问题最有效的方式是实现我国基本医疗保险的城乡统筹。早些年,国务院曾提出过“三保合一”即城镇职工基本医疗保险制度、新型农村合作医疗、城镇居民基本医疗保险制度三制度合一的目标,由于现目前三种制度在缴费标准和待遇享受方面还存在着较大的差异,“三保合一”并不能马上实现,而新型农村合作医疗和城镇居民基本医疗保险的“两保合一”却是具备了足够的社会经济条件,他们具有相似的参保原则、筹资标准和筹资模式。本文采用了比较分析法和案例分析法,首先对整合城乡居民基本医疗保险的研究背景研究意义、文献综述和相关理论基础进行了介绍,其次对我国现行的基本医疗保险发展历程现状结构进行了梳理并提出了其存在的问题和对社会发展的影响,再次分析了整合城乡居民基本医疗保险的可行性和意义,最后以绵阳市整合城乡居民基本医疗保险为例,从绵阳市城乡居民基本医疗保险的参保对象、筹资机制、筹资水平、待遇和补偿水平、基金和组织管理这五个方面分别进行两种制度的对比分析,分析整合存在的问题,同时借鉴国内整合城乡居民基本医疗保险的试点的先驱城市成都市和常熟市的经验,主要从统一覆盖人群、统一筹资方式、统一筹资标准、统一补偿机制、基金风险控制和统一管理体制六个方面为绵阳市整合城乡居民基本医疗保险工作提出主要思路和建议。
[Abstract]:China has built a basic medical security system with Chinese characteristics, which is based on the basic medical insurance system for urban workers, the new rural cooperative medical care system, the basic medical care system for urban and rural residents and the medical assistance system for urban and rural residents. With more than 1.3 billion people covered, the universal health care system has been basically formed. However, with the further development of society. The malpractice of the urban-rural dual medical security system formed under the urban-rural dual household registration system is also increasingly apparent, which is mainly reflected in the lack of social equity, which is not conducive to the flow of human resources. It is not conducive to the sustainable development of the medical insurance system, at the same time caused the repeated financial subsidies carried out by the financial sector, urban and rural residents of repeated participation in the phenomenon. Relevant departments repeatedly establish information systems and agencies and other issues. The most effective way to solve this series of problems is to realize the urban and rural planning of basic medical insurance in China. The State Council has put forward the goal of "three guarantees in one", that is, the basic medical insurance system for urban workers, the new rural cooperative medical insurance system and the basic medical insurance system for urban residents. As there are still big differences between the three systems in payment standard and treatment enjoyment, "three guarantees in one" can not be realized immediately. However, the new rural cooperative medical insurance and the basic medical insurance of urban residents have sufficient social and economic conditions, and they have similar principles of participating in insurance. This paper uses comparative analysis and case analysis. Firstly, it introduces the research background significance, literature review and related theoretical basis of integrating basic medical insurance of urban and rural residents. Secondly, the current development process of basic medical insurance in China has been combed and the existing problems and the impact on social development have been put forward. The feasibility and significance of integrating the basic medical insurance of urban and rural residents is analyzed again. Finally, taking Mianyang City as an example to integrate the basic medical insurance of urban and rural residents, from the basic medical insurance of Mianyang urban and rural residents to participate in the object of medical insurance. Financing mechanism, funding level, treatment and compensation level, fund and organization management of these five aspects of comparative analysis of the two systems, analysis of the integration of the existing problems. At the same time draw lessons from the experience of Chengdu and Changshu, the pilot cities of integrating the basic medical insurance of urban and rural residents in China, mainly from the unified coverage of the population, unified funding methods, unified funding standards, unified compensation mechanism. Six aspects of fund risk control and unified management system for Mianyang City to integrate the basic medical insurance of urban and rural residents put forward the main ideas and suggestions.
【学位授予单位】：西南科技大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

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