京津沪三地医疗保险比较研究

发布时间：2018-05-14 23:08

本文选题：京津沪 + 医疗保险　；参考：《北京交通大学》2014年硕士论文

【摘要】：上世纪九十年代末,我国开始进行城镇职工基本医疗保险制度改革；2003年开始,我国开始在农村地区开展新型农村合作医疗制度；2007年开始开展城镇居民(非从业人员)基本医疗保险制度的试点,目前我国已初步形成了城乡居民全部纳入医疗保险网络结构的格局。但是,由于地区经济发展的不平衡等原因,同时出现了城乡居民医疗保障待遇差距较大、不同地区居民之间医疗保障待遇悬殊等问题。甚至,即便是同一地区,不同就业形式的居民群体医疗保障待遇也不尽相同。如何在基于我国国情的基础上,发现我国基本医疗保险存在的主要问题,找出造成相关问题的根本原因,进而建立一个兼顾公平和效率的医疗保险制度,成为我国医疗保险制度当前面临的重要课题。本文主要采用文献分析法、内容分析法和比较分析法等方法,以京津沪三地为样本地区,第一,系统梳理和比较了京津沪三地医疗保险模式及发展上的差异。分析发现京津沪三地由于经济发展情况及其他因素影响,在医疗保险的实施模式及发展方向上略有差异。北京侧重于对医疗保险体系的构建,天津侧重于城乡医疗保险的统筹以及管理部门的统一,上海着力于发展全城医疗保险统筹(不分户籍,不分籍贯)。第二,分别从覆盖人群、参保现状、筹资机制与水平、保障待遇四个方面为维度对京津沪三地医疗保险进行了比较分析,对城镇职工基本医疗保险、城镇居民基本医疗保险和新型农村合作医疗制度三种医保制度进行了系统的比较分析,同时,在利用三省市数据并结合医疗保险相关理论分析的基础上,有针对性的提出了京津沪医疗保险存在的共性问题：就诊流向不合理、城乡医保制度仍缺乏衔接、基金结余率高于合理化水平和医疗保险经办管理能力有待提升以及具有各自特色的差异性问题。第三,通过深入研究发现,医疗保险支付方式不合理；城乡医保筹资标准、保障待遇上存在差距；医保基金支付机制过于谨慎,公众享受的医保待遇普遍过低；医保经办机构管理不统一,现有工作人员编制灵活性差；政府职能不到位,财政投入不足是形成上述问题的原因。最后,在以上分析的基础上,总结了京津沪三地医疗保险实施过程中的有益经验和问题原因,并同时结合了国外四种主流医疗保险模式经验启示,提出完善我国基本医疗保险制度的政策建议：完善医保支付方式、健全不同医保制度衔接机制、加大对医疗保险基金的监督、适当引入市场机制经办基本医疗保险、以及明确各级政府定位等。
[Abstract]:At the end of the 90s of last century, China began to reform the basic medical insurance system for urban workers and workers in cities and towns. In 2003, China began to carry out a new rural cooperative medical system in rural areas. In 2007, the basic medical insurance system for urban residents (non practitioners) began to be tested. At present, our country has initially formed the whole urban and rural residents. However, due to the imbalance of the regional economic development, the medical security treatment gap between urban and rural residents is large, and the medical insurance benefits of the residents in different regions are very big. Even in the same area, the medical insurance treatment of the residents in different forms of employment is not exhausted. On the basis of China's national conditions, how to find out the main problems of basic medical insurance in our country, find out the fundamental causes of the related problems and establish a medical insurance system with fairness and efficiency, which has become an important subject in the medical insurance system of our country.
This article mainly uses the methods of literature analysis, content analysis and comparative analysis, taking the three areas of Beijing, Tianjin and Shanghai as the sample area. First, it systematically combs and compares the differences in the medical insurance model and the development of the three places in Beijing, Tianjin and Shanghai. The analysis found that the three places in Beijing, Tianjin and Shanghai are in the implementation model of the medical insurance because of the economic development situation and other factors. There is a slight difference in the direction and direction of development. Beijing focuses on the construction of the medical insurance system. Tianjin focuses on the integration of urban and rural medical insurance and the unification of the management department. Shanghai focuses on the development of medical insurance in the whole city (not divided into household registration and native place). Second, the coverage of the population, the status of insurance, the financing mechanism and level, and the protection of treatment, respectively. The four aspects of the medical insurance in Beijing, Tianjin and Shanghai were compared and analyzed. The basic medical insurance of urban workers, the basic medical insurance of urban residents and the three kinds of medical insurance system in the new rural cooperative medical system were compared and analyzed. At the same time, the basic medical insurance system of the three provinces and cities was used to analyze the basis of the theory of medical insurance. On the other hand, the common problems in Beijing, Tianjin and Shanghai medical insurance are put forward: the flow of medical treatment is not reasonable, the medical insurance system in urban and rural areas is still lack of cohesion, the rate of fund surplus is higher than the level of rationalization and the management ability of medical insurance management needs to be promoted as well as the differential questions with its own characteristics. Third, medical insurance is found through in-depth research and medical insurance. The way of payment is unreasonable; there is a gap in the financing standard of medical insurance in urban and rural areas; the payment mechanism of the medical insurance fund is too cautious, the medical insurance treatment of the public is generally too low; the management of the medical insurance agencies is not unified, the flexibility of the existing staff is poor; the government functions are not in position and the financial input is insufficient to form the above problems original Finally, on the basis of the above analysis, it summarizes the beneficial experience and the cause of the implementation of the three places medical insurance in Beijing, Tianjin and Shanghai. At the same time, it combines the experience of the four mainstream medical insurance modes in foreign countries, and puts forward some suggestions to improve the basic medical insurance system in China: to perfect the way of medical insurance payment and to improve the medical insurance system. We should strengthen the supervision of medical insurance funds, introduce market mechanism to handle basic medical insurance, and define the position of governments at all levels.

【学位授予单位】：北京交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684

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