徐州市大病保险运行机制研究

发布时间：2018-05-10 21:11

本文选题：大病保险 + 筹资　；参考：《中国矿业大学》2017年硕士论文

【摘要】：城乡居民大病保险作为基本医疗保险的延伸和拓展,是为了防止城乡居民因病致贫、因病返贫而实施的。在PPP理论、福利多元主义理论和公共产品理论的指导下,大病保险在实施过程中开展公私合作,引入了市场竞争机制,采取由商业保险机构承办的方式,目的是为提高其经办效率和质量。自2012年国家发改委等六部委发布了关于实施城乡居民大病保险的意见后,大病保险的全国试点、推广工作就此铺开,后中央政府和各地政府亦出台了相关措施促使其进一步推广和实施。大病保险的实施各地因地制宜,取得不错成就,虽没有可以照搬的模式,但仍可以相互借鉴和促进。通过对徐州市大病保险运行现状的调查研究,发现徐州市大病保险运行机制中存在筹资渠道单一,统筹层次偏低;城乡待遇不同,赔付水平偏低;招投标不透明,存在亏损运营;公私合作有限,商保参与度不足;信息公开不足,社会监督缺位。分析得出主要是缘于大病保险过度依赖基本医疗保险,其制度基础和社会经济发展水平不同,商业保险机构缺乏大病保险运行经验,服务意识不强,政策宣传不到位。对此,提出精算筹资水平,拓宽筹资渠道;加强各方合作,增强服务意识;建立健全专业化的运营管理平台、承保管理体系、医疗风险控制机制和客户服务体系;完善信息公开与多方参与的监管制度。
[Abstract]:As an extension and expansion of basic medical insurance, urban and rural residents' serious illness insurance is to prevent urban and rural residents from becoming poor because of illness and returning to poverty because of illness. Under the guidance of PPP theory, welfare pluralism theory and public product theory, the major illness insurance carried out public-private cooperation in the implementation process, introduced the market competition mechanism, and adopted the way of undertaking by commercial insurance institutions. The aim is to improve the efficiency and quality of operation. Since the National Development and Reform Commission and other six ministries and commissions issued their opinions on the implementation of serious illness insurance for urban and rural residents in 2012, the national pilot project of the serious illness insurance has spread out. After the central government and local governments also issued measures to promote its further promotion and implementation. The implementation of serious illness insurance can be adapted to local conditions and has made good achievements, although there is no model to copy, but still can learn from each other and promote. Through the investigation and research on the operation status of serious illness insurance in Xuzhou, it is found that there are single financing channels, low overall planning level, different treatment between urban and rural areas, low compensation level, opaque bidding and bidding in Xuzhou serious illness insurance operation mechanism. There are loss-making operation, limited public-private cooperation, insufficient participation in business insurance, insufficient information disclosure and lack of social supervision. The main reason is that the insurance of serious illness depends on the basic medical insurance, its system foundation and the level of social and economic development are different, the commercial insurance institutions lack the operation experience of the insurance of serious illness, the service consciousness is not strong, and the policy propaganda is not in place. In view of this, the author puts forward the level of actuarial financing, widening the financing channel, strengthening the cooperation of all parties, strengthening the service consciousness, establishing and perfecting the specialized operation management platform, underwriting management system, medical risk control mechanism and customer service system. Improve the information disclosure and multi-participation regulatory system.
【学位授予单位】：中国矿业大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684

【参考文献】