不同基本医疗保险政府筹资受益归属研究

发布时间：2018-04-05 21:13

本文选题：基本医疗保险　切入点：政府筹资　出处：《宁夏医科大学》2017年硕士论文

【摘要】：研究背景1978年阿拉木图宣言提出“人人享有基本医疗服务”,2005年WHO又提出全民健康覆盖目标,确保人人享有基本医疗服务。基本医疗保险作为一种重要的方式保障居民能够获得基本医疗服务。中国从1998年建立城镇职工基本医疗保险开始,到2007年城镇居民基本医疗保险(以下简称城居保)试点,中国已基本建立覆盖不同人群的基本医疗保险体系。政府财政筹资作为基本医疗保险主要的筹资方式之一,居民通过卫生服务利用获得政府补助。居民基本医疗保险政府筹资受益如何?不同基本医疗保险人群的受益是否有差异?通过受益归属分析可以清晰解答这些问题。研究目标在分析不同基本医疗保险样本人群卫生服务利用的基础上,结合不同基本医疗保险基金的筹资补偿情况,分析不同基本医疗保险样本人群政府筹资补助受益分布情况;通过比较不同基本医疗保险政府筹资受益归属和公平性,为政府统筹城乡居民基本医疗保险制度的制定、实施提供证据支持和政策建议。研究方法采用文献复习法和描述性统计方法分析样本省不同基本医疗保险筹资补偿情况、样本人群的基本情况和卫生服务利用情况;运用受益归属分析不同基本医疗保险样本人群政府筹资补助受益分布情况;采用集中指数和集中曲线等分析样本人群政府筹资补助受益归属公平性。研究结果1.医保基金筹资补偿及卫生服务利用情况新型农村合作医疗保险(以下简称新农合)政府筹资占总筹资的82.66%,城居保政府筹资占总筹资的82.76%,其中住院支出是基本医疗保险基金主要支出。新农合两周患病率为19.64%,城居保两周患病率为23.43%。新农合两周就诊率为9.28%,城居保两周就诊率为8.44%,新农合样本人群两周就诊率高于城居保。2.受益归属分布情况新农合居民门诊补助受益最高的为中等收入组,占20.70%,受益最低的为较高收入组,为19.52%。城居保居民门诊补助受益最高为中等收入组为24.08%,最高收入组最低为16.36%。新农合居民住院补助受益最高的最高收入组为23.73%,较低收入组最低为17.43%。城居保居民住院补助最低收入组最少为15.29%,中等收入组为24.39%。新农合居民不同年龄门诊受益分布较不均衡,65岁及以上组12.24%的人口获得26.87%的补助;不同文化程度受益分布呈现文化程度越低,获得的补助越多的趋势。城居保居民门诊补助受益分布呈现年龄越大,相对人口比例来说获得的补助越多。新农合和城居保不同年龄及文化程度居民住院补助受益分布也不均衡,年龄高组和文化程度低组获得更多的补助。3.受益归属公平性新农合居民门诊补助集中指数为0.001,住院补助集中指数为0.025,新农合门诊补助集中曲线几乎与公平性重合,新农合居民门诊补助公平性好于住院补助公平性。城居保居民门诊补助集中指数为0.005,住院补助集中指数为0.031,高收入者获得较多补助,政府筹资补助呈现利富性。建议1.提高政府卫生财政投入的针对性,确保居民受益的公平性;2.加大对基层医疗服务机构投入,保障不同居民获得均等医疗卫生服务;3.精确计算医疗保险基金支出,合理确定合理报销方案;4.科学严谨制定城乡统筹基本医疗制度方案,确保城乡居民受益公平。
[Abstract]:On the background of the Almaty declaration of 1978 put forward the "universal access to basic medical services, the 2005 WHO proposed universal health coverage to ensure universal access to basic medical services. Basic medical insurance as an important way to protect the residents to obtain basic medical services. China from 1998 to establish the basic medical insurance for urban workers, the urban basic health insurance in 2007 residents (hereinafter referred to as the city home insurance) pilot, China has been basically established the basic medical insurance system covering different groups of people. One of the government finance basic medical insurance as the main mode of financing, the residents through health services to get government subsidies. The basic medical insurance for residents of government financing benefit? Different basic medical insurance groups benefit if there were differences through the analysis of benefit attribution? You can clearly answer these questions. The research target in the analysis The health service utilization based on basic medical insurance population, combined with the financing and compensation of different basic medical insurance fund financing, analysis of distribution of government subsidies for basic medical insurance in different populations; through the comparison of different basic medical insurance government financing benefit attribution and fairness, making for the basic medical insurance system for urban and rural residents and the government. Provide evidence to support the implementation and policy recommendations. The research methods include literature review and descriptive statistical analysis of samples of different funding of basic medical insurance compensation, the population and the basic situation of health service; use benefit attribution analysis of the fund distribution of government subsidies to different basic medical insurance population; the concentration curve and concentration index etc. Analysis of the sample population for government funding subsidies benefit fairness. Results 1 The health insurance fund. Compensation and health service of the new rural cooperative medical insurance (NCMS) government financing accounted for the total funding of 82.66%, the city ranks of government financing total financing 82.76%, the hospitalization expenditure is the basic medical insurance fund expenditure. The new IICA two week prevalence rate is 19.64%, the city ranks two the prevalence rate of 23.43%. new two week visiting rate was 9.28%, the city ranks two week visiting rate was 8.44%, two weeks treatment rate of NCMS population than the city ranks the sample.2. benefit distribution of NCMS outpatient subsidies for the highest middle-income group, accounting for 20.70%, the lowest for the benefit of higher income groups, 19.52%. City home insurance outpatient subsidies for the highest middle-income group was 24.08%, the highest income group is the lowest for 16.36%. residents NCMS hospitalization subsidy benefit highest of the highest income group is 23.73%, the lower income group A minimum of 17.43%. city ranks the residents of hospitalization for at least 15.29% of the lowest income group, middle income residents in different age group for the 24.39%. medical outpatient benefit distribution is not balanced, 65 years or more. 12.24% of the population get 26.87% subsidy; different cultural benefit distribution in the lower level of education, more subsidies obtained by city trend. Home insurance outpatient subsidy benefit distribution showed the older, more subsidies relative terms of the proportion of the population obtained. NCMS and the city ranks of different age and culture degree of residents hospitalization subsidy benefit distribution is not balanced, the high age group and low education group to get more subsidies.3. benefit fairness NCMS outpatient subsidy concentration index 0.001, hospitalization subsidy concentration index is 0.025, outpatient subsidies and equity concentration curves almost coincide, NCMS residents outpatient subsidy fairness To grant equity in hospital. The city ranks the outpatient subsidy concentration index was 0.005, hospitalization subsidy concentration index is 0.031, high earners get more subsidies, government funding subsidies appear rich. 1. suggestions to improve the government health investment, to ensure the fairness of residents from 2.; increase investment in primary health care different security services, residents equal access to health services; 3. the accurate calculation of the expenditure of health insurance fund, reasonable reimbursement scheme; 4. scientific develop urban and rural basic medical system, urban and rural residents to ensure fair benefit.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

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