旬邑县城乡居民基本医疗保险一体化研究

发布时间：2018-06-05 09:22

本文选题：医疗保险一体化 + 城乡居民医疗保险　；参考：《西北大学》2013年硕士论文

【摘要】：由于长期以来城乡经济发展水平的不同,二元经济社会成为我国的典型表现。现阶段我国的社会医疗保险也是处于城乡有别的状态,但是随着社会经济的变化,国家政策对于医保的调整方向有所改变。从2003年“统筹城乡发展”的提出,到2009年新医改的全面展开,再到2012年十八大报告中对“加大统筹城乡发展力度,促进城乡共同繁荣”的再次强调,城乡居民医疗保险一体化的试点开始陆续出现。本文以我国城乡基本医疗保险一体化改革现状的分析为基础,对旬邑县“城乡居民新型合作医疗”与就原来的医疗保险(新型农村合作医疗制度和城镇居民基本医疗制度)在参保对象、筹资标准、待遇标准、经办机构、基金管理、网络建设六方面进行了比较和分析后,指出新政策实现了城乡居民的全体覆盖、提高了居民医疗保险待遇和参保积极性,增强了基金的抗风险能力,并且为城镇居民就医提供了极大便利。其次,根据旬邑县城乡居民新型合作医疗经办中心所提供的数据,本文从参保状况、患者流向、基金的使用和分配、人群受益情况四方面入手,具体的对比分析了2010年-2012年各个方面数据的增长与变化。得出以下结论：旬邑县城乡居民新型合作医疗提高了居民参保积极性与人群受益度；合理分配了患者流向,促进了基层卫生事业的良性发展；提高了基金的使用效率,使基金分配趋于合理；逐步提高了参保人群受益度,减轻了居民看病负担；促进了城乡协调发展、符合社会发展要求。最后,结合我国不同试点运行情况和对旬邑县改革效果的分析,本文建议,若想更好更平稳的进行城乡基本医疗保险一体化改革,可以同步推行以下方面：将商业保险机制引入城乡基本医疗保险体系中,提高居民保障水平；将卫生部门作为主管部门统一管理城乡基本医疗保险的运行实施；同步推进户籍制度改革,打破城乡分割的局面；因地制宜,在整合过程中逐步统一缴费与待遇支付水平；加强基层人才队伍建设,提高基层医疗卫生服务水平。
[Abstract]:For a long time, dual economy society has become the typical performance of our country because of the different development level of urban and rural economy. At present, the social medical insurance of our country is also in a different state of urban and rural areas, but with the change of social economy, the adjustment direction of national policy on medical insurance has changed. From the proposal of "coordinating urban and rural development" in 2003, to the comprehensive development of the new medical reform in 2009, to the report of the 18th National Congress of 2012 on "strengthening the overall planning of urban and rural development and promoting the common prosperity of urban and rural areas", Urban and rural residents of medical insurance integration of the pilot began to appear one after another. This paper is based on the analysis of the status quo of the reform of basic medical insurance in urban and rural areas. To Xunyi county "urban and rural residents new cooperative medical care" and the original medical insurance (new rural cooperative medical care system and the basic medical care system of urban residents) in the insured object, funding standards, treatment standards, agencies, fund management, After comparing and analyzing the six aspects of network construction, it is pointed out that the new policy has realized the overall coverage of urban and rural residents, improved the residents' medical insurance treatment and enthusiasm for participating in insurance, and strengthened the fund's ability to resist risks. It also provides great convenience for urban residents to seek medical treatment. Secondly, according to the data provided by Xunyi urban and rural residents' new cooperative medical service center, this paper starts from four aspects: the status of insurance participation, the flow of patients, the use and distribution of funds, and the benefits of the crowd. The specific comparative analysis of the 2010-2012 data growth and change in all areas. Draw the following conclusions: Xunyi urban-rural residents of the new cooperative medical care to improve the enthusiasm of residents and the benefits of the population; reasonable distribution of patients, promote the benign development of grass-roots health services; improve the efficiency of the use of funds, The distribution of funds tends to be reasonable; the benefit degree of insured population is raised step by step; the burden of medical treatment of residents is reduced; the coordinated development of urban and rural areas is promoted, which conforms to the requirements of social development. Finally, combined with the operation of different pilot projects in China and the analysis of Xunyi County reform effect, this paper suggests that, if we want to better and more smoothly carry out the urban and rural basic medical insurance integration reform, The following aspects can be implemented simultaneously: introducing the commercial insurance mechanism into the urban and rural basic medical insurance system to improve the residents' security level, taking the health sector as the competent department to uniformly manage the operation and implementation of the basic medical insurance in urban and rural areas; Simultaneously promote the reform of household registration system, break the situation of urban and rural segmentation; adjust measures to local conditions, gradually unified payment and treatment payment level in the process of integration; strengthen the construction of grass-roots talent team, improve the basic level of medical and health services.
【学位授予单位】：西北大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684

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