我国城乡居民大病保险基金收支平衡问题研究

发布时间：2018-08-22 20:04

【摘要】：近年来,重大疾病发病率逐年上升,医疗费用逐年增加,城乡居民“因病致贫、因病返贫”的现象屡屡上演。为解决这一问题,国家于2012年8月建立了城乡居民大病保险制度。大病保险制度实施四年多以来,有效减轻大病患者的个人医疗负担。然而,大病保险能否实现长期可持续经营是一个备受关注的问题,而可持续的核心便是大病保险基金的收支平衡。本文以城乡居民大病保险基金的收入和支出作为研究对象,分析我国31个省、市、区的大病保险基金平衡现状以及未来25年内基金的可持续性,据此提出相应的政策建议。首先,本文对大病保险的基本概念进行界定,介绍大病保险的相关理论。其次,分别对国内外现有的大病保险筹资方式和补偿方式进行分析。再次,基于我国的大病保险筹资方式和补偿方式,构建大病保险基金的筹资模型和费用补偿模型,以此测算出当前我国31个省、市、区的大病保险基金收支结余现状。最后,基于筹资模型和费用补偿模型,构建大病保险基金的盈余过程模型并测算未来25年内各个省、市、区的大病保险基金盈余情况,根据测算结果分析各地区大病保险基金收支的可持续性,而后对筹资比例和补偿比例等指标进行敏感性分析。通过对基金收支的测算,本文发现未来25年内绝大多数省份将面临大病保险基金收不抵支的问题,而这一问题可能导致多数省份的大病保险制度存在不可持续性。敏感性分析结果显示筹资比例、补偿比例以及合规住院费用比例会影响大病保险基金的收支状况,本文据此提出构建长效的筹资机制、建立合理的补偿机制等政策建议。
[Abstract]:In recent years, the incidence of major diseases has increased year by year, medical costs have increased year by year. In order to solve this problem, the state established the urban and rural residents serious illness insurance system in August 2012. Since the implementation of the serious illness insurance system for more than four years, the personal medical burden of patients with severe illness has been effectively alleviated. However, whether the insurance of serious illness can realize long-term sustainable management is a question of great concern, and the core of sustainability is the balance of income and expenditure of the insurance fund for serious illness. Taking the income and expenditure of urban and rural residents' serious illness insurance fund as the research object, this paper analyzes the balance of the fund in 31 provinces, cities and districts and the sustainability of the fund in the next 25 years, and puts forward corresponding policy suggestions. First of all, this paper defines the basic concept of serious illness insurance, introduces the related theory of serious illness insurance. Secondly, this paper analyzes the existing financing and compensation methods of major illness insurance at home and abroad. Thirdly, based on the methods of raising funds and compensation for serious illness insurance in our country, this paper constructs the financing model and cost compensation model of serious illness insurance fund, and then calculates the current situation of the balance of income and expenditure of the serious illness insurance fund in 31 provinces, cities and regions of our country. Finally, based on the financing model and the cost compensation model, this paper constructs the surplus process model of the major illness insurance fund and measures the surplus situation of the major illness insurance fund in each province, city and district in the next 25 years. According to the calculated results, the sustainability of the income and expenditure of the major illness insurance fund in various regions is analyzed, and then the sensitivity analysis of the financing ratio and the compensation ratio is carried out. Based on the calculation of fund income and expenditure, this paper finds that most of the provinces will face the problem of whether or not the income of the insurance fund will not be offset in the next 25 years, and this problem may lead to the unsustainable of the major illness insurance system in most provinces. The results of sensitivity analysis show that the proportion of financing, the proportion of compensation and the proportion of hospital expenses in compliance will affect the income and expenditure of the insurance fund for serious illness. Based on this, this paper puts forward some policy suggestions such as constructing a long-term financing mechanism and establishing a reasonable compensation mechanism.
【学位授予单位】：华侨大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

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