北京市基本医疗保险制度一体化研究
发布时间：2018-07-27 11:16
【摘要】：随着我国经济的快速发展,人民生活水平的稳步提升,人们对身体健康和生存质量的要求越来越高,医疗费用也日益增长,居民个人负担随之增加,因病致贫、因病返贫的情况时有发生。基本医疗保险是涉及人民群众切身利益的重要问题,受到党中央及全社会的关注和重视。我国现行基本医疗保险制度体系,由城镇职工基本医疗保险制度、城镇居民基本医疗保险制度和新型农村合作医疗制度构成。这三项制度虽然在政策层面已几乎达到覆盖全民,但其在统筹层次、筹资方式、基金管理、参保原则、缴费水平、保障程度等方面存在着巨大的差别,不能体现公平性,存在统筹层次低、医疗资源分配不合理、保障水平低、管理机构林立、行政成本高的弊端,引起了广大民众的不满,不利于基本医疗保险制度持续稳定的运行和发展。本文遵循发现问题、分析问题、解决问题的思路,以北京市基本医疗保险制度为研究对象,以罗尔斯的公平理论、庇古的福利经济学理论和贝弗里奇模式理论为指导,通过文献分析法和比较研究法,分析了北京市基本医疗保险制度分立的现状,总结了造成分立局面的历史、经济、政策原因,并从保险覆盖不全面、报销原则不一致、付费方式不统一、就医限制不同、经办机构重复设立等方面论证了基本医疗保险制度进行一体化改革的必要性。本文选取英国和荷兰为例,介绍其基本医疗保险制度的内容以及变革历程,英国是自建立之初就确定统一制度的典型,而荷兰是由分立的基本医疗保险制度改革成一体化制度的比较成功的案例,都具有一定的代表性,其先进经验对我国基本医疗保险制度的一体化改革有很大的借鉴意义。本文提出了分阶段实现北京市基本医疗保险制度一体化改革的方案,第一阶段,实现各险种内不同参保类型的统一;第二阶段,实现不同险种间制度的统一。基本医疗保险制度一体化的实现对于我国保障人才自由流动、保险待遇的顺利衔接、劳动力的保护和供给、保障公平性上有巨大意义,也能解决我国目前基本医疗保险统筹层次低、抗击风险能力弱、保障水平低、行政成本高的弊端。
[Abstract]:With the rapid development of our country's economy and the steady improvement of people's living standard, people's demands on health and quality of life are becoming higher and higher, the medical expenses are also increasing day by day, and the personal burden of the residents is increasing, resulting in poverty due to illness. The return to poverty from illness occurs from time to time. The basic medical insurance is an important issue concerning the vital interests of the people, which has received the attention and attention of the CPC Central Committee and the whole society. The current basic medical insurance system in China consists of the basic medical insurance system for urban workers, the basic medical insurance system for urban residents and the new rural cooperative medical insurance system. Although these three systems have almost reached universal coverage at the policy level, there are huge differences in the overall planning level, the way of raising funds, the fund management, the principle of participating in insurance, the level of contributions, the degree of security, and so on, which cannot reflect fairness. The malpractice of low overall level, unreasonable distribution of medical resources, low level of security, numerous administrative organizations and high administrative costs has caused dissatisfaction among the general public and is not conducive to the continuous and stable operation and development of the basic medical insurance system. This paper follows the train of thought of finding problems, analyzing problems, solving problems, taking the basic medical insurance system of Beijing as the research object, taking Rawls' theory of fairness, Pigou's theory of welfare economics and Beveridge's model theory as the guidance. Through the method of literature analysis and comparative research, this paper analyzes the present situation of the separation of basic medical insurance system in Beijing, summarizes the historical, economic and policy reasons for the separation, and analyzes the reasons for the incompleteness of insurance coverage and inconsistent reimbursement principles. The necessity of the integration reform of the basic medical insurance system is demonstrated in the aspects of different payment methods, different medical access restrictions and repeated establishment of the agencies. This paper takes Britain and the Netherlands as examples to introduce the content and reform process of the basic health insurance system. The United Kingdom is a typical example of establishing a unified system since the beginning of its establishment. The Netherlands is a relatively successful case from a separate basic medical insurance system to an integrated system, which has certain representativeness, and its advanced experience has great reference significance for the integration reform of our country's basic medical insurance system. This paper puts forward a scheme to realize the integration reform of the basic medical insurance system in Beijing in stages. In the first stage, the unification of different types of insurance is realized within the different types of insurance, and the second stage, the unification of the system among different kinds of insurance is realized. The realization of the integration of the basic medical insurance system is of great significance in ensuring the free flow of talents, the smooth convergence of insurance treatment, the protection and supply of labor force, and the guarantee of fairness in our country. It can also solve the problems of low overall level of basic medical insurance, weak ability of resisting risk, low level of security and high administrative cost.
【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】：2017
【分类号】：R197.1;F842.684
本文编号：2147644
[Abstract]:With the rapid development of our country's economy and the steady improvement of people's living standard, people's demands on health and quality of life are becoming higher and higher, the medical expenses are also increasing day by day, and the personal burden of the residents is increasing, resulting in poverty due to illness. The return to poverty from illness occurs from time to time. The basic medical insurance is an important issue concerning the vital interests of the people, which has received the attention and attention of the CPC Central Committee and the whole society. The current basic medical insurance system in China consists of the basic medical insurance system for urban workers, the basic medical insurance system for urban residents and the new rural cooperative medical insurance system. Although these three systems have almost reached universal coverage at the policy level, there are huge differences in the overall planning level, the way of raising funds, the fund management, the principle of participating in insurance, the level of contributions, the degree of security, and so on, which cannot reflect fairness. The malpractice of low overall level, unreasonable distribution of medical resources, low level of security, numerous administrative organizations and high administrative costs has caused dissatisfaction among the general public and is not conducive to the continuous and stable operation and development of the basic medical insurance system. This paper follows the train of thought of finding problems, analyzing problems, solving problems, taking the basic medical insurance system of Beijing as the research object, taking Rawls' theory of fairness, Pigou's theory of welfare economics and Beveridge's model theory as the guidance. Through the method of literature analysis and comparative research, this paper analyzes the present situation of the separation of basic medical insurance system in Beijing, summarizes the historical, economic and policy reasons for the separation, and analyzes the reasons for the incompleteness of insurance coverage and inconsistent reimbursement principles. The necessity of the integration reform of the basic medical insurance system is demonstrated in the aspects of different payment methods, different medical access restrictions and repeated establishment of the agencies. This paper takes Britain and the Netherlands as examples to introduce the content and reform process of the basic health insurance system. The United Kingdom is a typical example of establishing a unified system since the beginning of its establishment. The Netherlands is a relatively successful case from a separate basic medical insurance system to an integrated system, which has certain representativeness, and its advanced experience has great reference significance for the integration reform of our country's basic medical insurance system. This paper puts forward a scheme to realize the integration reform of the basic medical insurance system in Beijing in stages. In the first stage, the unification of different types of insurance is realized within the different types of insurance, and the second stage, the unification of the system among different kinds of insurance is realized. The realization of the integration of the basic medical insurance system is of great significance in ensuring the free flow of talents, the smooth convergence of insurance treatment, the protection and supply of labor force, and the guarantee of fairness in our country. It can also solve the problems of low overall level of basic medical insurance, weak ability of resisting risk, low level of security and high administrative cost.
【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】：2017
【分类号】：R197.1;F842.684
【参考文献】
相关期刊论文 前10条
1 梅红霞;;淄博市整合城乡居民基本医疗保险制度研究[J];山东行政学院学报;2014年10期
2 陈雪丽;;城镇居民医保与新农合作制度并轨问题探讨[J];现代经济信息;2014年17期
3 秦绍娟;谢昆谕;黄雅琪;;城乡一体化的基本医疗保障制度研究[J];经济论坛;2014年08期
4 彭浩然;;殊途可以同归——城乡居民医疗保险制度整合的路径与关键问题[J];中国人力资源社会保障;2014年02期
5 张天舒;;内蒙古新农合与城镇居民基本医疗保险制度存在的问题与对策[J];内蒙古科技与经济;2013年03期
6 谢思典;;整合城镇居民医保和新农合 构建城乡居民医疗保险一体化[J];办公室业务;2012年19期
7 可顺祥;田家鸿;;深化医药卫生体制改革 新平县城乡居民基本医疗保障一体化工作显成效[J];创造;2012年08期
8 殷俊;陈天红;;中国城镇居民医疗保险和新型农村合作医疗衔接路径探讨——基于湖北省武汉市的实证分析[J];社会保障研究;2012年03期
9 齐刚;;城乡居民医疗保险体系的构建——以河北省保定市为例[J];河北大学学报(哲学社会科学版);2012年03期
10 金维刚;;统筹城乡医保的困境与出路[J];中国医疗保险;2012年04期
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