红河州农村大病医疗保险分析
发布时间：2018-11-04 11:28
【摘要】：农村大病医疗保险是当前我国社会医疗保障制度的重要组成部分,与城镇职工基本医疗保险、城镇居民基本医疗保险、新型农村合作医疗制度和城乡医疗救助制度等共同构成社会医疗保障体系。对于广大农村居民来说,罹患重大疾病将面临巨大的医疗风险和经济风险,尽快建立农村大病医疗保险制度,能够维护和改善农村居民的健康状况,切实保障农村居民的健康权益,满足他们的基本医疗服务需求,有效缓解因罹患大病造成的严重经济负担和医疗负担,减少导致出现“因病致贫、因病返贫”、甚至家庭陷入绝境的社会现象,在促进社会公平方面发挥至关重要的作用。 本文考察了国内外对医疗保险制度领域开展研究的理论渊源及演进过程,阐述“福利国家”概念,研究农村医疗保险制度的经济学理论,国外发达国家开展农村大病医疗保险所采取的模式,国内发达地区已经取得的成功经验,以及政府与发展农村大病医疗保险的关系。 重点关注当今世界五种常见的医疗保险模式,即：以英国为代表的国家型医疗保险,以德国为代表的社会型医疗保险,以美国为代表的商业型医疗保险,以韩国为代表的社会医疗保险模式,以新加坡为代表的储蓄性医疗保险,针对社会中部分风险承受能力比较脆弱的人群而设计的特别限定型医疗保险。借鉴国内发达地区推进农村大病医疗保险的成功经验,包括江苏省太仓模式和广东省湛江模式,以及全国各地开展的各具特色的实践活动,研究其成功经验与教训。 本文从作者从业经历出发,研究商业保险公司参与农村大病医疗保险的优势与劣势,参与管理的几种主要方式,为农村大病医疗保险管理发挥着积极的促进作用。文中还论述了“逆选择困境”对农村大病医疗保险可能造成的伤害,提出了积极应对的策略。 文章深入分析云南省红河州的实际情况,探索在经济发展比较落后的边疆、少数民族聚居区更好地开展农村大病医疗保险的有效途径,更好地为广大农村居民服务。一是建议整合城镇职工基本医疗保险、城镇居民基本医疗保险、新型农村合作医疗,建立统一的全民医保体系,发挥基础性作用。二是建立统一的全民大病医疗保险制度,作为全民医保体系的有力补充,覆盖城乡全体居民,既体现公平、公正,又可避免陷入逆选择困境,引致危机。三是建议明确经济发达地区反哺经济落后地区、城镇反哺农村的财政政策,切实降低农村居民参加全民医保体系和全民大病医疗保险制度的经济成本。四是鼓励基层组织积极进行社会医疗保险制度创新。五是用制度激励商业保险公司全面参与全民医保体系和全民大病医疗保险制度的经营管理,坚持保本微利原则,发挥专业优势,以城乡居民满意度为评价标准,不断提高经营管理水平。六是采取有效措施切实提高农村地区医疗机构的服务水平,从根源上解决农村居民就近就医的实际需求。
[Abstract]:The medical insurance in rural areas is an important part of the social security system in our country. It forms a social medical security system with basic medical insurance, basic medical insurance for urban residents, new rural cooperative medical service system and urban and rural medical assistance system. For the vast rural residents, suffering from major diseases will be faced with great medical risk and economic risk, establish the rural large-disease medical insurance system as soon as possible, can maintain and improve the health condition of the rural residents, effectively guarantee the health and interests of the rural residents, To meet their basic medical service needs, effectively alleviate the severe economic burden and medical burden caused by the disease, reduce the social phenomenon leading to the occurrence of 鈥淏e poor due to illness and return to poverty due to illness鈥，
本文编号：2309688
[Abstract]:The medical insurance in rural areas is an important part of the social security system in our country. It forms a social medical security system with basic medical insurance, basic medical insurance for urban residents, new rural cooperative medical service system and urban and rural medical assistance system. For the vast rural residents, suffering from major diseases will be faced with great medical risk and economic risk, establish the rural large-disease medical insurance system as soon as possible, can maintain and improve the health condition of the rural residents, effectively guarantee the health and interests of the rural residents, To meet their basic medical service needs, effectively alleviate the severe economic burden and medical burden caused by the disease, reduce the social phenomenon leading to the occurrence of 鈥淏e poor due to illness and return to poverty due to illness鈥，
本文编号：2309688
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