商业健康保险与社会办医协同发展的可行性研究

发布时间：2018-07-07 14:53

本文选题：医疗保障 + 医改　；参考：《北京交通大学》2013年硕士论文

【摘要】：当前,我国已经建成了世界上规模最大的医保体系,覆盖了将近13亿人口,解决了一个人口大国最基本的医疗保障问题,取得了令世界瞩目的成就。但我国目前还处于社会主义初级阶段,经济、社会发展水平还有限,尽管医疗卫生总费用从2005年约8,700亿元增长到至今的约18,000亿元,但我们也发现,我国的人均卫生消费仅仅约1,300元,位于世界卫生组织的193个成员国中第114位,属于中等偏下水平。看病难、看病贵的问题依然是我国医疗保障体系需要解决的头等大事。为此,构建多种制度、模式的多层次、多元化医疗保障体系和医疗卫生服务体系,已经成为我国本次深化医改工作中,解决实际问题的基本共识。商业健康保险在我国医疗保障体系中位于第三个层次,它的发展目标应该是遵循市场机制,解决百姓在基本医疗保障之外的多元需求。由于当前的我国的政策环境,以及商业健康保险机构自身存在的诸多问题,其发展速度还比较缓慢,难以满足我国医保体系建设和广大百姓对多元化健康保障的需要。另外,在本次深化医改工作中,发展社会办医,扩大医疗服务供给,也是解决"看病难、看病贵"问题的主要办法之一。虽然社会办医近几年发展迅速,但在政策相对滞后,行业环境不够理想,基本医保定点资格受限等因素的制约下,以及自身发展过程中的一些积累问题的影响下,其发展速度和水平也难以满足社会需要。本文在众多探索商业健康保险和社会办医自身所处环境、所需政策、所面临的挑战和发展策略等孤立研究之外,拓宽了研究思路,提供了较新的研究视角,并紧密结合实际,从实现商业健康保险与社会办医协同发展的目标入手,通过对大量文献的深入研究和对比分析,采用网络检索、研究对象访谈等方法收集数据和现实依据,结合有关经济学理论,尝试找出两者之间协同发展的基础、协同发展模式,并对协同发展过程中的一些现实问题进行分析、研究,提供一定的解决思路。
[Abstract]:At present, China has built the largest medical insurance system in the world, covering nearly 1.3 billion people. It has solved the most basic medical security problem in a populous country, and has made remarkable achievements in the world. However, China is still in the primary stage of socialism, and the level of economic and social development is still limited. Although the total cost of medical and health care has increased from about 870 billion yuan in 2005 to about 1.8 trillion yuan so far, we have also found that China's per capita health consumption is only about 1300 yuan, ranking 114th among the 193 member countries of the World Health Organization. The problem of difficult and expensive medical treatment is still the top priority of our medical security system. Therefore, the construction of a variety of systems, multi-level model, diversified medical security system and medical and health service system has become the basic consensus in the deepening of medical reform in China, to solve practical problems. Commercial health insurance is at the third level in the medical security system of our country. Its development goal should be to follow the market mechanism and solve the multivariate needs of the common people beyond the basic medical security. Because of the current policy environment of our country and many problems existing in the commercial health insurance institutions, the development speed is still slow, which is difficult to meet the needs of the construction of the medical insurance system and the diversified health security of the masses of people in our country. In addition, it is one of the main ways to solve the problem of "difficult to see a doctor and expensive to see a doctor" to develop the social medical service and expand the medical service supply in the course of deepening the medical reform. Although social health care has developed rapidly in recent years, under the constraints of relatively lagging policies, inadequate industry environment, restricted qualification for basic medical insurance, and some accumulated problems in the process of its own development, Its development speed and level also difficult to meet the social needs. In addition to many isolated studies, such as exploring the environment, policies, challenges and development strategies of commercial health insurance and social health care, this paper broadens the research ideas, provides a new research perspective, and closely combines with practice. Starting with the goal of realizing the cooperative development of commercial health insurance and social medical management, through the in-depth study and comparative analysis of a large number of documents, this paper collects data and realistic basis by means of network retrieval, research object interview and so on. Combined with the relevant economic theory, this paper tries to find out the foundation and mode of cooperative development between the two, and analyzes some practical problems in the process of cooperative development, studies them, and provides some ideas for solving them.
【学位授予单位】：北京交通大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684;R197.1

【参考文献】