整合城乡基本医疗保险制度的地方创新模式研究

发布时间：2018-03-26 04:01

本文选题：城乡基本医疗保险　切入点：整合　出处：《山西大学》2017年硕士论文

【摘要】：近年来,整合城乡基本医疗保险制度已经是我国医疗保险制度发展的主要趋势,因城乡分割而“碎片化”的医疗保险制度问题凸显:公平性的缺失、重复性参保、制度难以衔接、统筹层次低等,在中央尚缺顶层设计的情况下,从2008年开始一些地方政府都不约而同地自发地探索医疗保险制度的整合,各地政府结合本地的实际情况进行创造性地整合,不仅将“碎片化”的制度整合起来,而且也提高了医保制度的公平性和保障性,随之也涌现出了各具特色的整合模式,这些各具特色的整合模式不仅为未整合地区提供了示范和经验基础,而且也推动了其他地区进行医疗保险制度的整合,而2016年国务院文件《关于整合城乡基本医疗保险制度的意见》的出台,更是为未整合地区提供了强大的政策支撑,将整合工作正式提上了日程。本文通过对以往整合城乡基本医疗保险的典型实践模式进行归纳分类:“三合一”大一统模式、“三合二”渐进统一模式和“三合二”再商保模式,然后比较其异同,从实施方案、管理体制、筹集机制和待遇支付四个方面对三大类模式进行不同的比较分析,从整合之路、整合之首、整合之力和整合之旨四个方面总结了三大类模式的共性特征为整合城乡基本医疗保险制度的有益经验,再对各地整合过程中遇到的诸如顶层设计不统一、制度碎片难衔接、统筹层次比较低、资源配置不均衡、经办机构能力低和监督管理不健全等障碍和问题,针对性地提出了优化整合城乡基本医疗保险制度的对策建议:完善顶层设计、健全衔接机制、提高统筹层次、均衡城乡资源、提高经办能力和加强监督管理,为今后未整合的地方提供实践示范和理论指导。
[Abstract]:In recent years, the integration of urban and rural basic medical insurance system has been the main trend of the development of medical insurance system in China. The system is difficult to link up, the overall planning level is low, and while the central government still lacks a top-level design, some local governments have spontaneously explored the integration of the medical insurance system since 2008. The local governments creatively integrate the local conditions, not only to integrate the fragmented system, but also to improve the fairness and security of the health care system. With this, various integration modes have emerged with their own characteristics. These unique integration models not only provide a model and empirical basis for unintegrated areas, but also promote the integration of medical insurance systems in other regions. And the publication of the 2016 State Council document "opinions on the Integration of Urban and Rural basic Medical Insurance system" provides a strong policy support for unintegrated areas. The integration work has been formally put on the agenda. This paper summarizes and classifies the typical practice models of integrating urban and rural basic medical insurance in the past: "three in one" model, "three in two" progressive unification mode and "three in two" renegotiation mode. Then compare its similarities and differences, from the implementation of the scheme, management system, fund-raising mechanism and treatment payment four aspects of the three major models of different comparative analysis, from the road of integration, integration of the first, The four aspects of integration force and integration aim sum up the common features of the three major models: the beneficial experience of integrating the basic medical insurance system between urban and rural areas, and then the integration process encountered in various places such as the design of the top layer is not uniform, the system fragments are difficult to link up. Some obstacles and problems, such as relatively low overall planning level, unbalanced allocation of resources, low capacity of administrative organizations and imperfect supervision and management, are put forward to optimize and integrate the basic medical insurance system between urban and rural areas: to perfect the top-level design, We should perfect the connection mechanism, improve the overall planning level, balance the urban and rural resources, improve the administrative ability and strengthen the supervision and management, and provide practical demonstration and theoretical guidance for the unintegrated places in the future.
【学位授予单位】：山西大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

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