青岛市城镇基本医疗保险模式探析

发布时间：2018-11-17 07:23

【摘要】：在人类面临的诸多风险中,疾病风险是涉及面广、复杂多样、危害严重、直接关系到人类基本生存的特殊风险。医疗保障是一项基本的社会保障。任何国家的居民都将面临疾病风险以及与疾病风险有关的医疗服务、医疗保险等问题。人的一生可以躲过失业风险,躲过意外伤害的风险,但谁也躲不过老和病。对此,许多国家把保障国民健康规定在宪法中,并提出具体的目标和原则,形成了自己的社会医疗保障体系。由政府组织实施覆盖全体人民的基本医疗保险,是现代国家的通行制度,是公民享有的基本权利。适宜的社会医疗保障制度是维护居民健康状况,提高生活质量,促进社会经济发展的根本保障。本文通过对青岛市城镇基本医疗保险管理的实证分析,总结出青岛市城镇基本医疗保险模式,并进行一些理论上的思考。首先通过总结国内外关于医疗保险管理的相关研究,在此基础上明确了研究目的和研究意义,构建了本文研究的基本思路、研究方法和研究框架和内容。其次,概述了青岛市城镇基本医疗保险的基本情况,主要包括青岛市城镇职工、居民基本医疗保险制度框架和主要政策。第三,总结青岛市城镇基本医疗保险模式及成功经验。青岛市城镇基本医疗保险主要是以“三个目录、两个定点、一个结算办法”为核心的管理模式,在十多年的管理实践中,城镇基本医疗保险覆盖人数迅速增加·,医疗保障能力持续增强,医疗保障待遇水平稳步提高,医疗保险管理政策体系逐步完善。第四,在总结青岛市城镇基本医疗保险模式及成功经验的基础上,提出青岛市城镇基本医疗保险存在的问题及解决对策建议,应不断完善支付办法,实现医保基金稳健运行；继续推进门诊统筹,加快医疗保险向社区转移；探索完善各项机制,降低基金支出,强化诚信医保建设。通过对青岛市城镇基本医疗保险模式进行分析研究,将进一步推动青岛市的医疗保障工作在维护参保人权益、促进全市经济发展和社会稳定方面发挥更积极的作用。
[Abstract]:Among the many risks faced by human beings, the risk of disease is a special risk that involves a wide range of areas, is complex and diverse, and has serious harm, which is directly related to the basic survival of human beings. Medical security is a basic social security. Residents of any country will face disease risk and health care, health insurance and other issues related to disease risk. One can avoid unemployment risk and accidental injury risk in one's life, but no one can escape old age and illness. In this regard, many countries put the provision of national health protection in their constitutions, and put forward specific goals and principles, forming their own social medical security system. The basic medical insurance which covers all the people by the government is the current system of the modern country and the basic right enjoyed by the citizens. The proper social medical security system is the fundamental guarantee to maintain the residents' health condition, improve the quality of life and promote the social and economic development. Based on the empirical analysis of the management of basic medical insurance in Qingdao, this paper sums up the mode of basic medical insurance in Qingdao, and makes some theoretical considerations. Firstly, by summarizing the relevant research on medical insurance management at home and abroad, the purpose and significance of the research are clarified, and the basic ideas, research methods, research framework and contents of this paper are constructed. Secondly, it summarizes the basic situation of the basic medical insurance in Qingdao, mainly including the framework and main policies of the basic medical insurance system for the urban workers and residents in Qingdao. Third, summarize the basic medical insurance model and successful experience of Qingdao. Qingdao's basic medical insurance in cities and towns is mainly based on the "three catalogs, two fixed points, one settlement method" as the core management model. In more than ten years of management practice, the number of people covered by the basic medical insurance in cities and towns has increased rapidly. The ability of medical insurance has been continuously strengthened, the level of medical insurance treatment has been steadily improved, and the policy system of medical insurance management has been gradually improved. Fourth, on the basis of summing up the basic medical insurance mode and successful experience of Qingdao city, the paper puts forward the problems and countermeasures of the basic medical insurance in Qingdao, which should improve the payment method and realize the steady operation of the medical insurance fund. We will continue to promote out-patient coordination, speed up the transfer of medical insurance to the community, explore and improve various mechanisms, reduce fund expenditures, and strengthen the construction of health insurance in good faith. Through the analysis and research on the basic medical insurance model of Qingdao city, it will further promote the medical security work in Qingdao to play a more active role in safeguarding the rights and interests of the insured and promoting the economic development and social stability of the whole city.
【学位授予单位】：中国海洋大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684

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