W市城镇职工基本医疗保险费用控制及影响因素研究

发布时间：2018-09-12 11:11

【摘要】：在我国,社会医疗保险制度正在全国范围内逐步改革和推广,改革后的医疗保险制度是否能够实现用比较合理的费用提供比较优质的医疗服务,从而实现满足广大群众基本医疗服务需求的目标,既关系着广大人民群众的切身利益能否实现,又关系到新的医疗保险制度是否能持续运行。城镇职工基本医疗保险作为社会医疗保险制度的重要内容,是为劳动者在因生病而蒙受经济损失之后给予一定经济补偿时建立的一项医疗保险制度。城镇职工基本医疗保险制度实行单位和个人按一定比例共同缴费,参保职工生病产生的医疗费用由医疗保险经办机构通过医疗保险基金给付参保人员一定的经济补偿,从而减轻参保人员因生病和治疗等医疗需求所承受的经济负担。在w市实行城镇职工基本医疗保险以来,医疗保险费用的支出也不断上涨,医院、患者之间的信息不对称导致了道德风险的存在。如果不加强w市城镇职工基本医疗保险费用的控制,医疗保险基金将出现收不抵支的状况,这将会影响到基金的使用,城镇职工基本医疗保险制度的持续发展将会受到威胁。因此,遏制w市城镇职工基本医疗保险费用的不合理增长势在必行。本文运用了经济学、统计学方法,从w市城镇职工基本医疗保险的实际情况出发,从需求方和供给方两方面建立影响城镇职工基本医疗保险费用支出的模型。根据模型的建立和分析,并结合国外和国内典型城市医疗保险费用控制的可借鉴经验,针对W市城镇职工基本医疗保险费用控制提出合理性建议,从而推进W市城镇职工基本医疗保险制度的顺利实施。
[Abstract]:In China, the social medical insurance system is gradually being reformed and popularized throughout the country. Will the reformed medical insurance system be able to provide relatively high quality medical services at a more reasonable cost? Thus, the goal of meeting the basic medical service needs of the masses is not only related to whether the vital interests of the masses can be realized, but also whether the new medical insurance system can continue to operate. As an important part of the social medical insurance system, the basic medical insurance for urban workers is a medical insurance system which is established for workers when they give certain economic compensation after they have suffered economic losses due to illness. The basic medical insurance system for urban staff and workers shall be jointly paid by units and individuals in a certain proportion. The medical expenses arising from the illness of the insured workers shall be paid by the medical insurance agencies through the medical insurance fund to pay certain economic compensation to the insured personnel. Thus reducing the insured due to illness and treatment and other medical needs to bear the economic burden. Since the implementation of basic medical insurance for urban workers in w city, the expenditure of medical insurance costs has also been rising, and the asymmetric information between hospitals and patients has led to the existence of moral hazard. If we do not strengthen the control of the cost of basic medical insurance for urban staff and workers in w city, the medical insurance fund will appear the situation that the income does not exceed the expenditure, which will affect the use of the fund, and the sustainable development of the basic medical insurance system for urban workers will be threatened. Therefore, it is imperative to curb the unreasonable increase of the cost of basic medical insurance for urban workers in w city. Based on the economic and statistical methods and the actual situation of the basic medical insurance for urban workers in w city, this paper sets up a model from the demand side and the supply side, which affects the expenditure of the basic medical insurance expenses of the urban workers. According to the establishment and analysis of the model, combined with the experience of medical insurance cost control in foreign and domestic typical cities, this paper puts forward some reasonable suggestions for the cost control of basic medical insurance for urban workers in W city. Thus, the implementation of the basic medical insurance system for urban workers in W City is carried out smoothly.
【学位授予单位】：西南交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684

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