营口市城乡居民医疗保险制度并轨研究

发布时间：2018-11-22 12:30

【摘要】：随着社会进步经济发展,我国医疗卫生行业发展稳定,我国公众基本医疗保险制度基本落实。基本医疗保险作为社会保障体系的重要组成部分,是消除城乡居民“看病难,看病贵”问题的根本而有效的制度安排。城镇居民基本医疗保险与新型农村合作医疗两种制度互为补充,基本覆盖了我国绝大部分的城镇和农村居民,但由于城乡差异的存在,产业结构的调整,城市化进程的加速,造成两种制度独立运行,无法互通有无,同时也很难转移和进行有效承接,造成了现有资源的浪费和不合理运用。因此,为了实现“全民医保”,我国在部分地区先后进行了城居医保和新农合制度衔接和整合的有益尝试,积累了一定的宝贵实践经验。本文以逆向选择理论、公平理论、统筹城乡理论、公平理论、公共物品理论等公共管理学相关理论为理论基础,对国内外基本医疗保险制度研究情况加以总结,为本文课题研究提供参考。以辽宁省营口市为例,对城镇居民医疗保险与新型农村合作医疗并轨问题加以研究。通过对区域内城镇居民医疗保险与新型农村合作独立运行存在的问题及问题成因,对两种基本医疗保险制度并轨进行可行性分析,借鉴国内外的相关成功经验,探索解决问题的对策建议。通过对辽宁省营口市的城镇居民医疗保险和新型农村合作医疗的政策和现状对比,两种制度在参保对象覆盖人群、筹资方式及标准、报销支付方式及医保待遇等几个方面存在差异。而两种基本医疗保险制度的独立运行产生又产生了以下问题,即城乡二元分割的医保制度缺乏公平、个人缴费的组织成本高、多头管理浪费资源、政府监管不力、自愿参与的“逆向选择”与“道德风险”隐患、统筹层次低导致抗风险性差等。通过对营口市医疗保险制度的相关讨论,又将发达国家的先进经验进行总结,本文阐述了营口市城乡居民医疗保险制度并轨的对策建议,即加大政府投入、实现城乡居民户籍制度一元化、建立“一制多档”的缴费标准和待遇标准、统筹管理体制、加强对医疗机构的监督、确定长期的参保关系等。通过以上论述,对现阶段营口市城乡居民医疗保险制度并轨的可行性进行了探讨,从而能够在一定程度上为进一步探索构架符合我市实际的城乡居民医疗保险体制和机制,完善相关政策及制度设计提供参考和借鉴。
[Abstract]:With the development of society and economy, the development of medical and health industry in China is stable, and the basic medical insurance system of our country is basically implemented. As an important part of the social security system, the basic medical insurance is the fundamental and effective institutional arrangement to eliminate the problem of "difficult to see a doctor, expensive to see a doctor" for urban and rural residents. The basic medical insurance of urban residents and the new rural cooperative medical system complement each other and cover the vast majority of urban and rural residents in China. However, due to the existence of differences between urban and rural areas, the adjustment of industrial structure, the acceleration of urbanization. As a result, the two systems operate independently and can not be used for each other. At the same time, it is very difficult to transfer and undertake effectively, which results in the waste and unreasonable utilization of existing resources. Therefore, in order to realize the "universal medical insurance", China has carried out a beneficial attempt to link up and integrate the urban health insurance system and the new rural cooperative system in some areas, and accumulated some valuable practical experience. Based on reverse selection theory, equity theory, urban-rural theory, equity theory, public goods theory and other related theories of public management, this paper summarizes the research situation of basic medical insurance system at home and abroad. It provides a reference for the research of this paper. Taking Yingkou City, Liaoning Province as an example, this paper studies the integration of urban residents' medical insurance and new rural cooperative medical system. This paper analyzes the feasibility of the two basic medical insurance systems by analyzing the problems and the causes of the problems existing in the independent operation of the regional urban residents' medical insurance and the new type of rural cooperation, and draws lessons from the relevant successful experience at home and abroad. Explore the countermeasures and suggestions to solve the problem. By comparing the policies and current situation of urban residents' medical insurance and new rural cooperative medical insurance in Yingkou City, Liaoning Province, the two systems cover the population, financing methods and standards. Reimbursement payment method and medical insurance treatment and so on several aspects exist the difference. However, the independent operation of the two basic medical insurance systems has produced the following problems: the lack of fairness in the dual urban-rural medical insurance system, the high organization cost of individual contributions, the waste of resources by multiple management, and the weak supervision of the government. Voluntary participation of "adverse selection" and "moral hazard" hidden dangers, low co-ordination level lead to poor risk resistance and so on. By discussing the medical insurance system of Yingkou City and summarizing the advanced experience of the developed countries, this paper expounds the countermeasures and suggestions for the integration of the medical insurance system of the urban and rural residents of Yingkou City, that is, to increase government investment. To realize the unification of the household registration system of urban and rural residents, to establish the standard of payment and treatment of "one system and multi-file", to coordinate the management system, to strengthen the supervision of medical institutions, and to determine the long-term relationship between participation and insurance, etc. Through the above discussion, this paper probes into the feasibility of merging the urban and rural residents' medical insurance system in Yingkou at this stage, so as to further explore the system and mechanism of medical insurance for urban and rural residents in accordance with the actual situation in our city to a certain extent. Improve the relevant policies and system design to provide reference and reference.
【学位授予单位】：大连海事大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684;R197.1

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