吉林省城镇职工基本医疗保险制度存在问题与对策研究

发布时间：2018-05-31 04:03

本文选题：城镇职工 + 医疗保险　；参考：《东北师范大学》2014年硕士论文

【摘要】：医疗保险制度作为一项具有高度社会需求性的基本制度，一项保障和改善民生的重点制度，一项事关实现经济社会可持续发展的关键制度，一直以来都是我国医疗卫生事业的重点建设领域。从计划经济时代的劳保医疗和公费医疗并行的医疗保障制度开始，基本医疗保险制度中的城镇职工人群始终是系统建设的优先领域。随着改革开放的推进，传统的城镇职工医疗保障体制赖以生存的制度基础逐渐发生改变，劳保医疗过渡到社会医疗保险的改革势在必行。时至今日，城镇职工基本医疗保险制度改革的深化和推进也成为化解“看病难、看病贵”难题的题中之义，其制度设计、运行和管理各方面都面临着一些问题和挑战。本文从认识继续推进和深化城镇职工基本医疗保险制度改革的理论和现实意义入手，，在进行了相关的理论准备后，开始对吉林省城镇职工基本医疗保险制度存进行抽丝剥茧地研究。首先就医疗保险制度的相关概念、基本原则、建立意义等做出简要回顾和强化，并将世界范围内，包括德国的社会医疗保险模式，美国的商业医疗保险模式，英国的国家医疗保险模式，新加坡的储蓄医疗保险模式四种典型的医疗保险模式进行了比较研究，对后文吉林省城镇职工基本医疗保险制度的运行分析提供了坚实理论基础。接着，本文回溯了我国城镇医疗保障制度的历史沿革，从传统的劳保医疗和公费医疗到意识到传统城镇医疗保险制度的弊端后的城镇职工基本医疗保险制度的阶段性改革探索。最后，回到本文的研究重点吉林省城镇职工基本医疗保险制度存在的问题，对此笔者着重从三个角度进行了分析，制度覆盖面问题，尚未达到预期目标；政策管理问题，制度方案有待优化；统筹层次问题，抗风险能力差。相应的，针对提出的问题，文中也提出了对策建议，通过尽快解决历史遗留问题和重点、难点突出的扩面工作扩大与提升制度覆盖的深度与广度；通过拓宽医保基金的筹资来源，完善对需方的偿付制度、对供方的激励和支付制度等方面调整完善相关政策和管理机制；通过建立完善的信息平台和继续推进统筹层次提高以期更好地发挥制度的互助共济功能。
[Abstract]:The medical insurance system is a basic system with high social needs, a key system to protect and improve the people's livelihood, a key system related to the realization of sustainable economic and social development. All along is our country medical and health enterprise key construction domain. Starting from the parallel medical security system of labor insurance and public medical treatment in the planned economy era, the urban workers and staff members in the basic medical insurance system are always the priority areas of the system construction. With the development of reform and opening up, the system foundation on which the traditional medical insurance system for urban workers depends on is gradually changing, so it is imperative to reform the transition of labor insurance medical care to social medical insurance. Up to now, the deepening and promotion of the reform of the basic medical insurance system for urban workers has also become the meaning of resolving the difficult and expensive medical treatment. The design, operation and management of the system are facing some problems and challenges. This paper begins with the theoretical and practical significance of continuing to promote and deepen the reform of the basic medical insurance system for urban workers, and after making relevant theoretical preparations, The basic medical insurance system for urban workers in Jilin Province began to be studied. First of all, briefly review and strengthen the related concepts, basic principles and significance of the medical insurance system, and make a brief review and strengthen the social medical insurance model of the world, including the social medical insurance model of Germany, the commercial medical insurance model of the United States, etc. This paper makes a comparative study of the four typical medical insurance modes in Britain and Singapore, which provide a solid theoretical basis for the operation and analysis of the basic medical insurance system for urban workers in Jilin Province. Then, this paper retrospect the historical evolution of the urban medical security system in China, from the traditional labor insurance and public medical care to the realization of the drawbacks of the traditional urban medical insurance system after the reform of the basic medical insurance system of urban workers stage exploration. Finally, returning to the problems existing in the basic medical insurance system of urban workers in Jilin Province, the author analyzes the problems from three angles, the coverage of the system has not yet reached the expected goal, the policy management problem, The system plan needs to be optimized; the overall planning level problem, the ability to resist risk is poor. Accordingly, aiming at the problems raised, the paper also puts forward some countermeasures and suggestions, through solving the problems and key points left over by history as soon as possible, expanding and improving the depth and breadth of the coverage of the system, which is difficult and prominent; By broadening the funding sources of the medical insurance fund, perfecting the reimbursement system to the demand-side, adjusting and perfecting the relevant policy and management mechanism in the respect of the incentive and payment system of the supplier; By building a perfect information platform and continuing to promote the overall level of improvement in order to better play the system of mutual aid function.
【学位授予单位】：东北师范大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;R197.1

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