云南省城乡居民医疗保障统筹衔接机制研究

发布时间：2018-10-14 08:49

【摘要】：随着时代和经济的发展,我国城乡、区域发展失衡,城乡发展差距不断加大,社会矛盾尖锐严重阻碍了社会稳定和经济发展的速度。人们对医疗卫生服务的需求加大,对医保的需求层次变得多样化,对公平的医疗服务呼声变高,落后的医保配套措施,难以满足群众的需求。建立与经济发展相适应的城乡医疗保险制度也应随之发生变化。现行的医疗保险制度在运行过程中出现“碎片化”、“多元化”的特征。具体在实践过程中表现为:城乡居民待遇差距较大,城乡居民医保出现衔接困难,待遇不公平等问题。随着工业化和城市化的推进,户籍制度被打破,人口流动和结构的变化,需要建立与之配套的医疗保险制度。本文通过对相关文献和具体实例进行分析,通过对基本理论的梳理,运用文献分析法和对比分析法对云南省现行的城镇职工医疗保险、城镇居民医疗保险、新农合政策进行综合研究,对医疗保险改革的具体政策进行理论和实践分析。现行的医疗保险制度由于制度设计不合理、筹资手段不足、资金监管措施不到位,实施程序不公平,严重阻碍了经济的发展。对医疗保障机制进行整合和政策衔接是社会发展的必然要求。云南省位于经济不发达的西部地区,地区经济发展不均衡,本地医疗保险政策在实施中也遇到了种种困难,对于医保统筹衔接机制更是需要进行整体化研究。具体的医保政策在实施的过程中需要按照循序渐进的原则进行,因地制宜的出台具体的政策建议,不能笼统的按照一个模式进行下去。因此,探寻一个适合云南省城乡医保的政策衔接机制就显得尤为重要了。本文通过对云南省城乡居民医疗保险的主要制度实施的模式、运行的基本状况,存在的问题以及我国城乡居民医保现状进行分析。针对医疗保险统筹衔接机制实施过程中出现的问题进行研究,通过对医改实施比较成功的地区,如上海市、安徽省宁国市、重庆市医保统筹整合衔接机制建设的成功经验进行典型研究。着力厘清云南省统筹城乡居民医疗保险制度,对分散的体制进行整合研究,指出推进制度一体化建设的必要性与可行性。针对整合衔接过程中出现的问题分析原因,通过借鉴各试点地区取得的成功经验,提出具体的解决措施和意见。并就云南省医保统筹衔接机制建设的制度模式和路径选择提出相应的对策建议。
[Abstract]:With the development of times and economy, the imbalance of urban and rural development and regional development in China, the increasing gap between urban and rural development, the sharp social contradictions seriously hinder the social stability and the speed of economic development. People's demand for medical and health services has increased, the demand for medical insurance has become diversified, the demand for fair medical services has become higher, and the backward matching measures of medical insurance are difficult to meet the needs of the masses. The establishment of urban and rural medical insurance system in accordance with economic development should also change with it. The current medical insurance system is characterized by fragmentation and diversification. In the process of practice, the difference of treatment between urban and rural residents is large, the medical insurance of urban and rural residents is difficult to link up, the treatment is unfair and so on. With the development of industrialization and urbanization, the household registration system has been broken, and the population flow and structure have changed, so it is necessary to establish a matching medical insurance system. Through the analysis of relevant documents and concrete examples, through combing the basic theory, using the literature analysis method and the comparative analysis method, this paper analyzes the current medical insurance of urban workers and urban residents in Yunnan Province. The new rural cooperative policy carries on the comprehensive research, carries on the theory and the practice analysis to the medical insurance reform concrete policy. The current medical insurance system is seriously hindered by the unreasonable design of the system, insufficient means of financing, inadequate supervision of funds and unfair implementation procedures. The integration of medical security mechanism and policy convergence is the inevitable requirement of social development. Yunnan Province is located in the underdeveloped western region, the regional economic development is not balanced, the local medical insurance policy has also encountered a variety of difficulties in the implementation of the medical insurance system is even more necessary to carry out a holistic study. The specific medical insurance policy in the process of implementation needs to be carried out in accordance with the principle of gradual and orderly, according to local conditions, the introduction of specific policy recommendations, can not be carried out in general according to a model. Therefore, it is particularly important to explore a policy convergence mechanism suitable for urban and rural health insurance in Yunnan Province. This paper analyzes the mode of implementing the main system of medical insurance for urban and rural residents in Yunnan Province, the basic status of operation, the existing problems and the present situation of medical insurance of urban and rural residents in China. Based on the study of the problems in the implementation of the medical insurance linkage mechanism, through the implementation of the more successful areas of medical reform, such as Shanghai, Ningguo City, Anhui Province, The successful experience in the construction of the medical insurance system in Chongqing is studied. This paper makes great efforts to clarify the medical insurance system of urban and rural residents in Yunnan Province, studies the decentralized system, and points out the necessity and feasibility of promoting the construction of institutional integration. This paper analyzes the causes of the problems in the process of integration and cohesion, and puts forward some concrete measures and suggestions through drawing lessons from the successful experiences of each pilot area. And put forward the corresponding countermeasures and suggestions on the institutional model and path selection of the construction of the overall linking mechanism of health insurance in Yunnan Province.
【学位授予单位】：云南财经大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684

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