由成都市统筹城乡医保改革引发对沈阳市医保制度的思考

发布时间：2018-05-29 22:11

本文选题：社会医疗保险 + 城乡统筹　；参考：《辽宁大学》2013年硕士论文

【摘要】：我国是城乡二元分割的经济社会结构，社会医疗保险制度二元分割、多维运行的体制是二元社会结构的具体体现。随着经济和生产力的发展，这种二元的社会结构逐渐成为经济社会深层次改革和进一步发展的桎梏。医疗保险制度的二元结构阻碍了劳动力的跨地域流动，也造成重复参保、财政重复补贴、管理经办资源重复投入等巨大浪费。上述情况降低了经济运行的效率，不公平不合理的再分配机制也直接影响了社会主义和谐社会的构建。为解决这些问题，部分地方政府根据党中央、国务院的指示，，结合当地实际情况，进行医疗保障领域的相关改革探索，创造出带有“地方性”和“区域性”特点的实践模式。其中，成都市统筹城乡医疗保险制度改革就是一个成功的典范，为其它地区，尤其是经济欠发达地区提供了参考借鉴的蓝本。沈阳市地处东部经济区，城乡居民收入水平较高且差距较小，同时具备较高的城镇化水平。但沈阳医疗保险制度至今仍然沿用城乡二元运行的体制，严重阻碍了生产力的发展和社会的公平进步。本文的目的是阐述成都市的成功实践是否可以被沈阳市所借鉴。第一章详细研究了成都市城乡医疗保险制度在政策、管理体制、经办体制及制度设计等方面的创新。第二章分析了成都市统筹城乡医疗保险制度改革取得的成效及其成功的关键原因，同时指出改革过程中面临的挑战和问题。第三章主要从两个城市经济发展水平、城乡居民收入差距、城镇化水平、政府财政能力及政府的改革意愿等角度加以对比，深入地分析了成都市统筹城乡医疗保险制度的模式是否可以被沈阳市所借鉴。结论是沈阳市较成都市具备更优裕的统筹城乡医疗保险制度条件，并且沈阳市在政治、经济、制度和社会支持度等方面都具备了统筹城乡医疗保险制度的现实基础。第四章则结合沈阳市的实际情况,借鉴成都市统筹城乡医保的成功做法，因地制宜地提出沈阳市统筹城乡医疗保险制度的总体构思和具体的政策建议，包括“三步走”的发展路径、多层次筹资和补偿机制的建立、统筹层次的提升、管理机构的统一、经办资源的整合、城乡医保政策和经办流程的统一等建议。
[Abstract]:Our country is the economic and social structure of the dual division of urban and rural areas, the dual division of the social medical insurance system, the system of multidimensional operation is the concrete embodiment of the dual social structure. With the development of economy and productive forces, this dual social structure has gradually become the shackles of the deep reform and further development of economic society. The dual structure of the medical insurance system hinders the labor force from moving across regions, and it also results in huge waste, such as repeated participation in insurance, repeated subsidy of finance, repeated input of administrative resources, and so on. The above situation has reduced the efficiency of economic operation, and the unfair and unreasonable redistribution mechanism has directly affected the construction of a harmonious socialist society. In order to solve these problems, some local governments, according to the instructions of the CPC Central Committee and the State Council, combined with the actual local conditions, carried out relevant reform and exploration in the field of medical security, and created a practical model with the characteristics of "local" and "regional". Among them, the reform of urban and rural medical insurance system in Chengdu is a successful example, which provides a reference for other regions, especially for the less developed areas. Shenyang is located in the eastern economic zone, the income level of urban and rural residents is higher and the gap is small, at the same time, it has a higher level of urbanization. However, Shenyang medical insurance system still follows the dual operation system of urban and rural areas, which seriously hinders the development of productive forces and the fair progress of society. The purpose of this paper is to explain whether the successful practice of Chengdu can be used for reference by Shenyang. The first chapter studies the innovation of urban and rural medical insurance system in Chengdu in terms of policy, management system, administration system and system design. The second chapter analyzes the effect of urban and rural medical insurance system reform in Chengdu and the key reasons for its success. At the same time, it points out the challenges and problems in the process of reform. The third chapter compares the economic development level of the two cities, the income gap between urban and rural residents, the level of urbanization, the financial capacity of the government and the willingness of the government to reform. This paper deeply analyzes whether the mode of urban and rural medical insurance system in Chengdu can be used for reference by Shenyang. The conclusion is that Shenyang has more favorable conditions than Chengdu in coordinating urban and rural medical insurance system, and Shenyang has the realistic foundation of urban and rural medical insurance system in politics, economy, system and social support. The fourth chapter combines the actual situation of Shenyang, draws lessons from the successful practice of urban and rural medical insurance in Chengdu, and puts forward the overall concept and specific policy recommendations of the overall urban and rural medical insurance system in Shenyang according to local conditions. It includes the development path of "three steps", the establishment of multi-level financing and compensation mechanism, the promotion of overall planning level, the unification of management organization, the integration of administrative resources, the unification of urban and rural medical insurance policy and operation process, and so on.
【学位授予单位】：辽宁大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684;R197.1

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