江西省三项基本医疗保险制度整合研究

发布时间：2018-05-13 16:15

本文选题：基本医疗保险制度 + 基金结余　；参考：《江西财经大学》2014年硕士论文

【摘要】：江西省自1999年开始实施城镇职工基本医疗保险制度改革以来,随着2003年、2007年新型农村合作医疗制度及城镇居民基本医疗保险制度的先后建立,逐步建立了包括城乡居民医疗救助在内的江西省基本医疗保障制度,实现了三项基本医疗保险在制度上的全覆盖。然而在医疗保障领域,我国城乡间基本医疗保险的差异是一直就存在的,江西省作为“中部崛起”城市之一,在整体经济欠发达及突出的“二元”经济特征等情况下,基本医疗保险制度也呈现典型的“二元”特征。城乡分割的“二元”医保不但阻碍“人人享有健康”的全民医保的进程,也带来了许多社会问题,国内外不少学者在如何整合三项基本医疗保险制度的问题上已经做了相关研究和努力。本文从三项基本医疗保险制度的基本理论出发,针对基本医疗保险制度内部缺陷和外部环境的问题,从医疗保险基金结余、财政投入等角度入手来对基本医疗保险城乡整合进行研究。本文通过规范分析法,首先,从江西省目前三项基本医疗保险制度的基本情况出发,以公共品理论作为探讨三项医疗保险制度城乡整合的理论基础,并对城乡基本医疗保险一体化的基本内涵进行了概述,提出了加快整合三项基本医疗保险制度是解决“看病难”、“看病贵”,构建城乡一体化社会保障体系,实现医保公平、社会公正和构建和谐社会的需要。然后,在此基础上,对江西省三项基本医疗保险制度的实施现状进行了论述,介绍了三项基本医疗保险之间存在的制度差异,并从制度内部差异和制度发展外部环境两个方面分析了三项基本医疗保险制度存在的问题。再次,通过借鉴试点地区在整合城乡基本医疗保险制度,推进三项基本医疗保险制度一体化方面取得的成功经验,确立了江西省整合三项基本医疗保险制度的基本思路,即要打破户籍、部门和地域界限,通过统一基本医疗保险管理体制,建立省内自由流动的医疗保险制度,实现人群全覆盖的基本医疗保险制度,实现这一目标的第一步就是要实现新型农村合作医疗制度与城镇居民基本医疗保险制度的整合。明确了完善公共卫生服务体系后,就加快整合江西省三项基本医疗保险制度,实现江西省医疗制度进一步公平、公正和服务的均等化,提出了相应的政策措施建议。在文章最后的总结部分,得出江西省三项基本医疗保险制度整合研究的基本结论：在不断扩大参保覆盖面的基础上,内部制度调整和外部环境优化相结合,加之各种保障措施来给江西省三项基本医疗保险制度整合保驾护航,促进制度整合稳定健康发展,并对构建和完善我国社会保障体系提出了预期设想。
[Abstract]:Since the implementation of the reform of the basic medical insurance system for urban workers in Jiangxi Province in 1999, with the establishment of the new rural cooperative medical insurance system and the urban residents' basic medical insurance system in 2003 and 2007, The basic medical security system of Jiangxi Province, including the medical assistance for urban and rural residents, was gradually established, and the full coverage of the three basic medical insurance systems was realized. However, in the field of medical security, the difference of basic medical insurance between urban and rural areas in China has always existed. Jiangxi Province, as one of the "rising cities in the central region", is in the condition of underdevelopment of the overall economy and prominent "dual" economic characteristics, etc. The basic medical insurance system also presents the typical "duality" characteristic. The "dual" medical insurance system, which is divided between urban and rural areas, not only hinders the process of universal health insurance for all, but also brings many social problems. Many scholars at home and abroad have made relevant research and efforts on how to integrate the three basic medical insurance systems. Based on the basic theories of three basic medical insurance systems, aiming at the internal defects of the basic medical insurance system and the problems of the external environment, this paper starts with the balance of the medical insurance fund. Financial investment and other angles to study the basic medical insurance urban and rural integration. In this paper, through normative analysis, first of all, starting from the three basic medical insurance systems in Jiangxi Province, taking the theory of public goods as the theoretical basis for the urban-rural integration of the three medical insurance systems, It also summarizes the basic connotation of the integration of urban and rural basic medical insurance, and points out that speeding up the integration of the three basic medical insurance systems is to solve the problem of "difficult to see a doctor", "expensive to see a doctor", to construct a social security system of integration of urban and rural areas, and to realize the fairness of medical insurance. Social justice and the need to build a harmonious society. Then, on this basis, the paper discusses the current situation of the implementation of the three basic medical insurance systems in Jiangxi Province, and introduces the differences between the three basic medical insurance systems. The problems of the three basic medical insurance systems are analyzed from the internal differences and the external environment of institutional development. Thirdly, through the successful experience of integrating the urban and rural basic medical insurance system and promoting the integration of the three basic medical insurance systems in the pilot areas, the author establishes the basic ideas of Jiangxi Province to integrate the three basic medical insurance systems. That is, to break the boundaries of household registration, departments and regions, to establish a medical insurance system of free flow in the province through the unification of the basic medical insurance management system, and to realize the basic medical insurance system with full coverage of the population. The first step to achieve this goal is to realize the integration of the new rural cooperative medical system and the basic medical insurance system of urban residents. After perfecting the public health service system, the author puts forward the corresponding policy and measures to accelerate the integration of the three basic medical insurance systems in Jiangxi Province, to realize the further fairness, justice and equalization of the medical care system in Jiangxi Province. In the last part of the article, we draw the basic conclusion of the three basic medical insurance system integration research in Jiangxi province: on the basis of expanding the coverage of participating insurance, the internal system adjustment and the external environment optimization are combined. In addition, all kinds of safeguard measures are used to guarantee the integration of three basic medical insurance systems in Jiangxi Province, to promote the stable and healthy development of the system integration, and to put forward a tentative plan for the construction and improvement of our social security system.
【学位授予单位】：江西财经大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;R197.1

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