从单一到多元：基本医疗保险付款人制度改革研究

发布时间：2018-06-07 23:51

本文选题：基本医疗保险 + 单一付款人　；参考：《首都经济贸易大学》2014年硕士论文

【摘要】：我国已经初步建立起城镇职工基本医疗保险、城镇居民基本医疗保险、新型农村合作医疗三大模块的基本医疗保险制度,保险经办主体是政府管理下的行政机构,政府扮演绝对的权威者,负责各经办机构的人权、事权和财权,这样的行政安排相对于市场机制而言产生了更多的官僚成本；经办机构之间也不存在竞争关系,它们是在各自区域内的唯一“付款人”,垄断带来的是资源的低效利用；被保险人是在国家的强制下参与其中,为消极的消费者而非积极的参与者。本文对我国基本医疗保险单一付款人制度的特征及其效应进行剖析,论证基本医疗保险实施多个付款人制度的必要性。从理论上来说,个人享有自己所珍视的自由,理应拥有在保险机构上用脚投票进行选择的权利,多个付款人制度允许被保险人在不同保险机构之间做出选择,重申了个人权利的价值。此外,多个付款人制度符合政府职能演变的诉求,政府职能应更多地从统治性职能向服务型职能转变,“多中心”成为更为优化的治理模式。最后,对中国目前制度发展的实现路径进行初步探讨,指出在目前的单一付款人的现状下,首先要剥离经办机构的行政属性,继而逐渐引入竞争机制,最终形成多个付款人制度。
[Abstract]:China has initially established a basic medical insurance system for urban workers, basic medical insurance for urban residents, and a new rural cooperative medical insurance system. The main body of the insurance agency is an administrative body under the administration of the government. The government plays the role of absolute authority and is responsible for the human rights, administrative and financial powers of the agencies. Such administrative arrangements have more bureaucratic costs than the market mechanism, and there is no competitive relationship between the agencies. They are the only "payers" in their respective regions, where monopolies bring about inefficient utilization of resources, and the insured participate under the compulsion of the state, as passive consumers rather than as active participants. This paper analyzes the characteristics and effects of the single payer system of basic medical insurance in China, and demonstrates the necessity of implementing multiple payers system in basic medical insurance. In theory, individuals have the freedom they value and should have the right to vote with their feet on insurance institutions, and the multi-payer system allows the insured to choose between different insurance institutions. The value of individual rights is reaffirmed. In addition, the system of multiple payers accords with the demands of the evolution of government functions, and the functions of government should be changed more from the dominant function to the service-oriented function, and "multi-center" becomes a more optimized governance model. Finally, the paper makes a preliminary discussion on the way to realize the development of China's current system, and points out that under the present situation of single payer, the administrative attributes of the agency should be stripped first, and then the competition mechanism should be gradually introduced. Finally, the system of multiple payers was formed.
【学位授予单位】：首都经济贸易大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;R197.1

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