江苏省非从业居民医疗保险制度评价与整合研究

发布时间：2018-05-14 16:59

本文选题：城镇居民医疗保险 + 新型农村合作医疗　；参考：《浙江财经学院》2013年硕士论文

【摘要】：城乡非从业居民医疗保险制度是社会保障制度的重要组成部分，也是保障公民健康权益的制度手段。然而我国城乡非从业居民在享受医疗保险方面存在“二元分割”的局面，不同身份群体之间医疗保险待遇不公平现象由来已久。进入新世纪，政府开始重视非从业居民医疗保险的价值，积极采取措施，，推动非从业居民医疗保险制度的发展。2010年新一轮的“医改”提出构建覆盖城乡居民的医疗保障体系，实现“全民医保”的宏伟构想，这为我国建立整合的居民医疗保险制度提供了契机。江苏省作为我国东部沿海经济发达地区之一，其城乡居民医疗保障体系建设在全国处于领先地位，2007年该省实现城乡居民医疗保险制度的全覆盖。2004年以来该省已有18个试点地区开展了整合非从业居民医疗保险的尝试，试图缩小城乡居民医疗保险待遇差距，减少农村居民医疗保险福利损失。通过几年探索，省内各试点地区整合实践取得了一些成绩，城乡居民满意度不断提升。但是在整合过程中依然存在法律依据缺乏、管理机构不一致、统筹层次偏低、基金财务可持续性差等问题。本文从居民医疗保险制度整合理论出发，介绍江苏省非从业居民医疗保险的发展历程，评价非从业居民医疗保险制度的发展状况，对比非从业居民医疗保险制度的主要内容，然后总结非从业居民医疗保险制度整合的模式，最后提出进一步完善非从业居民医疗保险整合政策的对策建议。文章共有五个部分：第一部分主要是对选题背景的阐述和国内外关于城乡非从业居民医疗保险制度研究内容的介绍，以及行文思路、研究方法和创新点等。第二部分主要是非从业居民医疗保险制度整合的理论研究。首先准确界定非从业居民医疗保险的内涵以及非从业居民医疗保险制度整合的概念。在此前提下，进一步分析制度整合的理论渊源和整合的静态与动态分析。第三部分通过对江苏省非从业居民医疗保险制度发展历程和发展现状的定性研究，了解制度发展过程中收获的经验和存在的不足。在此基础上，运用“结构—过程—结果—影响”的医疗保险经典评价方法，建立定量指标体系和评价标准，以江苏省城镇居民医疗保险为对象，客观评估江苏省非从业居民医疗保险制度的运行效果。第四部分将江苏省分为苏南、苏中、苏北三个区域，分别选择具有代表性的典型城市，对比分析城镇居民医疗保险和新型农村合作医疗这两个制度主要内容的异同。然后从公共政策学和制度经济学的视角阐述城居医保和新农合制度融合变迁过程，探索城乡居民医疗保险制度整合的路径、方式和模式，探寻影响制度整合的外部宏观环境因素和内部微观制度基础。最后测算初步整合后城乡统一的非从业居民医疗保险缴费率水平和政府在非从业居民医疗保险筹资方面所承担的财政负担情况。第五部分针对江苏省非从业居民医疗保险制度整合中所存在的问题，提出加强立法工作、理顺管理体制、分解财政责任、提高统筹层次等措施来推动居民医疗保险制度整合的顺利进行。
[Abstract]:The medical insurance system of urban and rural non employed residents is an important part of the social security system. It is also a system means to protect the rights and interests of citizens. However, the non employed residents in urban and rural areas have a "two yuan division" situation in the enjoyment of medical insurance, and the unfair treatment of medical insurance between different groups has a long history. In the new century, the government began to attach importance to the value of non employed residents' medical insurance, actively take measures to promote the development of medical insurance system for non employed residents in the new round of "medical reform" in.2010, to build a medical security system covering urban and rural residents, and to realize the macro concept of "medical insurance for all", which set up an integrated medical insurance for our country. The risk system provides an opportunity.
Jiangsu province is one of the economically developed areas in the eastern coastal areas of China, its urban and rural residents' medical security system is in the leading position in the country. In 2007, the province realized the full coverage of urban and rural residents' medical insurance system in the province for.2004 years, the province has carried out an attempt to integrate non industrial residents' medical insurance in 18 pilot areas, trying to narrow the urban and rural areas. After several years of exploration, the integration practice of the pilot areas in the province has achieved some achievements and the satisfaction of urban and rural residents has been improved continuously. However, there is still a lack of legal basis in the process of integration, the structure of management is not consistent, the overall planning level is low, and the fund is financially sustainable. Problems such as poor sex and so on.
Starting from the integration theory of residents' medical insurance system, this paper introduces the development course of non employed residents' medical insurance in Jiangsu Province, evaluate the development status of medical insurance system for non employed residents, compare the main contents of non employed residents' medical insurance system, and then summarize the mode of medical insurance system integration of non employed residents, and finally put forward the progress of the medical insurance system. To improve the integration policy of non resident medical insurance, there are five parts:
The first part is mainly the introduction of the background of the topic and the introduction of the research content on the medical insurance system of urban and rural non employed residents at home and abroad, as well as the line of thinking, research methods and innovation points.
The second part is mainly the theoretical research on the integration of medical insurance system for non practitioners. Firstly, it defines the connotation of non practitioners' medical insurance and the concept of the integration of non practitioners' medical insurance system. On this premise, the theoretical origin and the static and dynamic analysis of the integration are further analyzed.
The third part, through the qualitative research on the development process and the current situation of the non employed residents' medical insurance system in Jiangsu Province, understands the experience and shortcomings in the process of the system development. On this basis, the quantitative index system and evaluation standard are established by using the classic evaluation method of "structure process - result - influence". The objective of this study is to objectively assess the operation effect of medical insurance system for non employed residents in Jiangsu Province, taking the medical insurance of urban residents in Jiangsu as an example.
The fourth part divides Jiangsu province into South of Jiangsu, the Soviet Union and the northern three regions, choosing typical typical cities, comparing and analyzing the differences and similarities between the two systems of the urban residents' medical insurance and the new rural cooperative medical system, and then expounds the integration of the medical insurance and the new rural cooperative system from the perspective of public policy and institutional economics. The path, the way and the mode of the integration of urban and rural residents' medical insurance system are explored, and the external macro environment factors and the internal microcosmic system foundation of the system integration are explored. Finally, the level of the medical insurance payment rate of unemployed residents in urban and rural areas and the government's financing for non practitioners' medical insurance after the initial integration are calculated. The burden of financial burden.
The fifth part, aiming at the problems existing in the integration of medical insurance system for non employed residents in Jiangsu Province, proposes to strengthen the legislative work, straighten out the management system, decompose the financial responsibility and improve the overall level and so on to promote the integration of the residents' medical insurance system smoothly.

【学位授予单位】：浙江财经学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684

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