鞍山市城镇职工医保基金支付方式存在的问题与对策研究

发布时间：2018-04-27 03:19

本文选题：城镇职工 + 医保基金　；参考：《沈阳师范大学》2017年硕士论文

【摘要】：本文以我国三大医疗保险体系中最主要的城镇医疗保险为例,通过对医改试点城市鞍山市城镇职工医疗保险运行中保险基金支付方式的调研分析,提出其运行中存在的问题,重点采用调查法、分析比较法及案例分析法等来分析目前城镇职工医保基金支付方式体系、存在的问题分析比较得出结论;通过查阅国内外参考文献,借鉴成功经验提出对策。本文研究结果显示在医疗保险基金紧张的情况下,目前运行的按项目付费的医疗保险基金支付方式无法控制医疗费用的不合理增长,已经远远不能满足广大人民群众就医需求,急需构建一个在总额预付控制下以单病种付费为主的多元化支付体系,同时发挥政府主导作用,达到政府与市场、公平与效率、权利与义务的协调发展。本文共分绪论、城镇职工医保基金支付方式的理论基础、鞍山市城镇职工医保基金支付的现状及存在的问题、鞍山市城镇职工医保基金支付方式的调整对策、研究结论与未来展望五部分对上述问题进行阐述。本文创新点一是运用新古典经济学的供给需求理论,设计需方、供方及医疗机构社会医疗保险费用控制的三个构成要素的医疗保险付费方式控制的概念框架,并分析其中存在的问题及其成因,在此基础上借助罗斯福的社会保障思想、凯恩斯的国家干预思想、贝弗里奇报告中的福利国家思想,提出了问题的解决对策。二是以医保试点城市鞍山市为研究对象,运用了实例调查的研究方法对医疗保险费用支付方式的现状进行调查,并对调查结果进行实证分析并提出解决对策,所获得的研究成果对于当前辽宁地区医疗保险费用支付方式的改革、缓解医患矛盾提供了有效途径和值得借鉴的参考。
[Abstract]:Taking the most important urban medical insurance in the three major medical insurance systems of our country as an example, through the investigation and analysis of the insurance fund payment methods in the operation of medical insurance for urban workers in Anshan City, a pilot city of medical reform, the problems existing in the operation of the insurance fund are put forward. This paper mainly adopts the investigation method, the comparative method and the case analysis method to analyze the current payment system of the medical insurance fund for the urban workers and staff, and draws a conclusion by analyzing and comparing the existing problems, and puts forward the countermeasures by consulting the domestic and foreign references and drawing lessons from the successful experience. The research results of this paper show that under the condition of tight medical insurance fund, the current payment mode of the medical insurance fund paid by the project cannot control the unreasonable increase of the medical cost, and it is far from being able to meet the needs of the broad masses of the people for medical treatment. It is urgent to construct a multiplex payment system under the control of total advance payment with single disease, and at the same time give play to the leading role of the government to achieve the coordinated development of government and market, fairness and efficiency, rights and obligations. This paper is divided into the introduction, the theoretical basis of medical insurance fund payment for urban staff and workers, the current situation and existing problems of medical insurance fund payment for urban workers in Anshan city, and the adjustment countermeasures of medical insurance fund payment method for urban workers in Anshan city. Research conclusions and future prospects of the five parts to elaborate on the above issues. The first innovation of this paper is to use the supply demand theory of neoclassical economics to design the conceptual framework of the medical insurance payment mode control which is composed of three elements of the social medical insurance expense control of the demand-side, the supply-side and the medical institution. Based on the analysis of the existing problems and their causes, the author puts forward the solutions to the problems with the help of Roosevelt's social security thought, Keynes's thought of state intervention, and the welfare state thought in Beveridge's report. Second, taking Anshan City, a pilot city of medical insurance, as the research object, using the research method of case investigation to investigate the current situation of medical insurance expense payment, and to make an empirical analysis on the results of the investigation and put forward some countermeasures to solve the problem. The research results provide an effective way and a reference for the reform of medical insurance payment mode and the alleviation of doctor-patient contradiction in Liaoning.
【学位授予单位】：沈阳师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684

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