辽宁省医疗保险制度给付水平研究

发布时间：2018-10-31 19:41

【摘要】：改革和完善社会保障制度是新形势下社会发展的客观要求和必然趋势，医疗保险是社会保障体系中的重要内容。近几年来，医疗保险制度迅速发展的同时也带来了一系列的问题，一方面医疗费用迅速增长，另一方面给付水平仍然较低，因此，如何合理的调整医疗保险的给付水平将是一个重要的研究课题。医疗保险是指以保险合同约定的医疗行为的发生为给付条件的，为被保险人在接受诊疗期间所发生的医疗费用提供保障的保险。社会医疗保险是国家通过立法形式强制实施的，当被保险人因疾病接受医疗服务时按照规定进行的一种经济补偿制度。由于商业医疗保险在辽宁省实施的范围有限，所以本文研究的为社会医疗保险。辽宁省从2000年开始相继建立了城镇职工基本医疗保险医疗、新型农村合作医疗保险、城镇居民基本医疗保险制度，经过近十年的发展，医疗保险制度取得了长足的进步。但在医疗保险的具体实施过中，保险给付水平低、基金收支不平衡、医疗保险的补偿机制不完善等现象依然存在，特别是近几年，医疗费用逐年增长，“以药养医”的局面仍然存在，老百姓“看病难、看病贵”的问题也并没有得到解决，这些问题的发生严重制约着我省医疗保险制度的发展和完善。要想解决以上问题，首先要明确我省目前的医疗保险给付水平是多少，社会统筹和个人账户的金额能支付的比例是多少；其次要知道目前的这种给付水平与我们的筹资是否匹配；最后要有针对性的提出问题的建议。因此通过对辽宁省目前医疗保险给付水平的比较分析，找出我给付水平存在的问题，并如何在基金容许的范围内适当提高给付水平，并将是本文需要着重解决的问题。本文主要采用定性研究和定量研究相结合的方式，从辽宁省医疗保险给付水平的实际情况出发，对医疗保险制度进行简单的总结和归纳，，采用定量的分析方法对辽宁省现有的医疗保险的给付水平进行测算，着重分析了在现有水平下所提供的医疗保险实际给付水平，并将其与筹资水平下应提供的给付水平进行比较，找出二者的差距。通过对世界上典型国家的医疗保险给付水平的比较和分析，结合辽宁省的实际情况，提出相应的对策及建议，进一步促进医疗保险的完善和发展。
[Abstract]:Reforming and perfecting the social security system is the objective requirement and inevitable trend of social development under the new situation. Medical insurance is an important content in the social security system. In recent years, the rapid development of the medical insurance system has also brought about a series of problems. On the one hand, the medical costs are increasing rapidly, on the other hand, the level of payment is still relatively low. How to adjust the payment level of medical insurance is an important research topic. Medical insurance refers to the insurance that takes the occurrence of medical behavior as the condition of payment and provides the insurance for the medical expenses incurred by the insured during the period of diagnosis and treatment. Social medical insurance is a kind of economic compensation system when the insured receives medical service because of illness. Because the scope of commercial medical insurance in Liaoning Province is limited, this paper studies social medical insurance. Since 2000, Liaoning Province has established the basic medical insurance system for urban workers, the new rural cooperative medical insurance system and the basic medical insurance system for urban residents. After nearly ten years of development, the medical insurance system has made great progress. However, in the specific implementation of medical insurance, the level of insurance payment is low, the fund income and expenditure are unbalanced, the compensation mechanism of medical insurance is not perfect and so on. Especially in recent years, the medical expenses have increased year by year. The situation of "raising medicine with medicine" still exists, and the common people's problem of "difficult to see a doctor, expensive to see a doctor" has not been solved, and the occurrence of these problems has seriously restricted the development and perfection of medical insurance system in our province. Want to solve above problem, want to clear our province current medical treatment insurance to pay level first, the amount that social overall planning and individual account can pay is what proportion; Second, we need to know whether the current payment level and our funding match, and finally to put forward targeted suggestions. Therefore, through the comparative analysis of the current level of medical insurance benefits in Liaoning Province, we can find out the problems existing in our payment level, and how to properly raise the level of payment within the scope allowed by the fund, which will be the problem this paper needs to focus on. This article mainly uses the qualitative research and the quantitative research the way, from Liaoning Province medical insurance payment level actual situation, carries on the simple summary and the induction to the medical insurance system, The quantitative analysis method is used to measure the payment level of the medical insurance in Liaoning Province, and the actual level of the medical insurance provided at the present level is emphatically analyzed. And compare it with the level of payment under the level of financing, and find out the gap between them. Through the comparison and analysis of the level of medical insurance payment in typical countries in the world, combined with the actual situation in Liaoning Province, the corresponding countermeasures and suggestions are put forward to further promote the improvement and development of medical insurance.
【学位授予单位】：辽宁大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684

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