辽宁省城乡医疗保险个人负担水平差距研究

发布时间：2018-03-19 00:37

本文选题：城乡医疗保险　切入点：个人医疗费用负担模型　出处：《辽宁大学》2014年硕士论文　论文类型：学位论文

【摘要】：我国一直致力于构建能够覆盖全民的社会医疗保障体系，在十多年的发展过程中，已经初步建立了具有中国特色的社会医疗保障体系。这个体系以社会基本医疗保险为核心，由多层次的医疗保障构成。城镇居民的社会基本医疗保险由城镇职工基本医疗保险和城镇居民基本医疗保险制度共同组成。农村居民的社会基本医疗保险由新型农村合作医疗保险制度进行保障。但是在实现全民医保的发展目标面前，虽然在政策上各地己经实现了全面覆盖，但是其实现的水平并不理想，城乡间在筹资水平与报销比例上存在较大差距。目前我国已经构建起世界上规模最大的医疗保障网，依据当前国家关于建立“全民医保”的构想，全体居民个人的医疗负担本应是一致的，但由于医疗保险多轨制使得医疗资源分配不公，城乡居民由于参加不同的医疗保险制度，筹资水平与报销政策存在较大差异，导致居民个人的医疗费用负担水平存在较大差距。本文首先介绍了相关概念及基础理论。着重对研究中需要使用的重要概念进行了内涵和外延的界定，，同时对生存公平与劳动公平理论、罗尔斯的正义论、公共物品理论等相关基础理论进行论述。然后阐述了辽宁省城乡医疗保险发展历程及筹资与给付的制度现状。概括了城乡医疗保险制度实施以来的筹资水平变动和调整的情况，以及门诊和住院的报销比例情况。采用两个指标分析城乡医疗保险个人负担水平的差距，建立了衡量医疗保险个人负担水平差距的模型，并通过采用模型假设以及大量的实证研究，分析城乡医疗保险个人医疗费用负担水平的差距。并分别分析了门诊医疗费用个人负担水平与住院医疗费用的个人负担水平。鉴于此分析造成城乡医疗保险个人负担水平差距的成因及后果。首先从造成医疗保险个人负担的政策原因、内在原因与外在原因进行考量，其次分析城乡医疗保险个人负担差距过大导致因病致贫、因病返贫，城乡经济差距加大的后果。最后基于城乡统筹一体化和“全民医保”的视角提出了缩小辽宁省城乡医疗保险个人负担水平差距、促进社会公平的政策建议。如提高统筹层次完善医疗保障水平、增加财政补贴促进城乡医疗保险公平、加强资金管理完善缴费机制、整合医疗资源实现医疗保障事业公平发展。
[Abstract]:Our country has been working hard to build a social medical security system that can cover all the people. In the course of more than 10 years of development, we have initially established a social medical security system with Chinese characteristics. The core of this system is social basic medical insurance. The social basic medical insurance of urban residents is composed of the basic medical insurance of urban workers and the basic medical insurance system of urban residents. The social basic medical insurance of rural residents is a new type. Rural cooperative medical insurance system is guaranteed. But in front of realizing the development goal of universal medical insurance, Although the overall coverage has been realized in all parts of the policy, the level of its realization is not ideal, and there is a big gap between the level of financing and the proportion of reimbursement between urban and rural areas. At present, China has built the largest medical insurance network in the world. According to the current concept of establishing "universal health insurance," the medical burden of all residents should be the same. However, the multi-track system of medical insurance makes the distribution of medical resources unfair, and the level of financing and reimbursement policy of urban and rural residents are quite different because of their participation in different medical insurance systems, which leads to a large gap in the level of individual medical expenses burden of residents. This paper first introduces the related concepts and basic theories. It focuses on the definition and extension of the important concepts that need to be used in the research. At the same time, it defines the theory of survival fairness and labor equity, Rawls' theory of justice. Then it expounds the development course of urban and rural medical insurance in Liaoning Province and the current situation of financing and payment system. It summarizes the changes and adjustments of the level of financing since the implementation of the medical insurance system in urban and rural areas. And the proportion of outpatient and inpatient reimbursement. Two indexes are used to analyze the gap between urban and rural medical insurance individual burden level, and a model to measure the difference of medical insurance individual burden level is established. And through the use of model assumptions and a large number of empirical research, This paper analyzes the difference between the level of individual medical expense burden in urban and rural medical insurance, and analyzes the level of individual burden of outpatient medical expenses and hospitalization medical expenses respectively. In view of this analysis, the individual medical insurance in urban and rural areas is caused by this analysis. The causes and consequences of the gap in burden level. First of all, from the policy reasons of the personal burden of medical insurance, The internal and external reasons are considered. Secondly, it is analyzed that the gap between the individual burden of urban and rural medical insurance is too large to lead to poverty due to illness, and to return to poverty because of illness. Finally, based on the integration of urban and rural areas and the perspective of "universal health insurance", the author proposes to narrow the gap in the level of individual burden of urban and rural medical insurance in Liaoning Province. Policy suggestions for promoting social equity, such as improving the overall level and improving the level of medical security, increasing financial subsidies to promote the equity of urban and rural medical insurance, strengthening the management of funds and perfecting the payment mechanism, integrating medical resources to achieve the equitable development of medical security.
【学位授予单位】：辽宁大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684

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