辽宁省农村大病保险收支平衡问题研究

发布时间：2018-11-27 19:17

【摘要】：2012年8月30日,人社部、卫生部、财政部等六部委联合发布《关于开展城乡居民大病保险工作的指导意见》,对于新农合参保人员和城镇居民医保大病负担重的这一问题,引入市场机制,建立大病保险制度,减轻城乡居民的大病负担。该制度是基本医疗保险报销后对城镇居民医保和新农合参保人的“二次报销”,制度的优势显而易见,有力的缓解了许多大病患者的个人负担。然而,在对大病保险制度的研究中,更多的人将研究的目光聚焦在大病保险的经办模式选择以及国外医疗保险制度的借鉴上,缺乏根据我国实际情况因地制宜的实证研究,特别是未来大病医疗保险基金收支的平衡问题,这一问题将关系到制度能否真正持续的运行下去。辽宁省是在全国范围内率先开展大病保险业务的地区之一。2013年3月,辽宁省农村居民大病保险业务试点工作开始正式启动,由于农村的经济发展水平、医疗水平、人均可支配收入低于城市,致使农村居民在面临大病风险支出时更加脆弱,因病致贫、因贫返贫的问题更容易发生。同时,从制度实际运行来看,辽宁省农村大病保险有着救治大病患者数量多、支出大的特点。2016年全省农村居民大病保险共补偿新农合患者10.59万人次,大病保险补偿支出4.67亿元,在这样的背景下,辽宁省农村未来的大病保险收支很难平衡,收不抵支的基金将难以为继,制度实施的可持续性也将不能得到保障,对辽宁省未来农村大病保险的收支测算十分必要,以达到大病保险制度动态调整的目标,应对基金风险与挑战,从而更好的满足辽宁省农村居民的医疗保障需求水平。本文主要包括五个部分的内容:第一部分为相关概念界定与理论基础,对大病及大病保险的相关概念进行界定,同时,选取相关理论作为本文研究的理论基础;第二部分为辽宁省农村大病保险的实施现状与问题,论述辽宁省农村大病保险制度当前的实施情况,探讨了与辽宁省农村大病保险收支的相关问题;第三部分为辽宁省农村大病保险收支平衡影响因素的实证分析,探寻影响辽宁省农村大病保险基金收支的因素,运用主成分分析法对各项指标进行分析,找出影响的主要因素进行重点分析;第四部分为辽宁省农村大病保险基金收支测算,分别设立大病保险基金收入与支出模型,考察大病保险未来的收支情况。通过预测未来辽宁省新农合基金的收支情况,考察新农合基金是否有进行大病保险补偿支出的能力以及引入大病保险制度对新农合基金有何种影响;第六部分为结论及对策建议,根据本文研究得出结论并做出说明,提出实现辽宁省大病保险收支平衡问题的对策及建议。
[Abstract]:On August 30, 2012, the Ministry of people's and Social Affairs, the Ministry of Health, the Ministry of Finance, and other six ministries jointly issued the guiding opinions on the Development of serious illness Insurance for Urban and Rural residents, which is an issue of heavy medical care burden for new rural co-operative insurance workers and urban residents. Introduce market mechanism, establish a serious illness insurance system, reduce the burden of serious illness of urban and rural residents. This system is the "second reimbursement" of the urban residents' medical insurance and the new rural cooperative insured after the reimbursement of basic medical insurance. The advantages of the system are obvious, which can alleviate the personal burden of many seriously ill patients. However, in the study of the serious illness insurance system, more people focus their attention on the choice of the management mode of the serious illness insurance and the reference of the foreign medical insurance system, and lack of empirical research according to the actual situation of our country. Especially the problem of balance of income and expenditure of medical insurance fund for serious illness in the future, this problem will affect whether the system can really continue to run. Liaoning Province is one of the first regions in the country to carry out serious illness insurance business. In March 2013, the pilot work of serious illness insurance for rural residents in Liaoning Province began to be officially started. Due to the level of economic development in rural areas, the level of medical treatment, The per capita disposable income is lower than that in urban areas, which makes rural residents more vulnerable when they face the risk of serious illness. At the same time, from the point of view of the actual operation of the system, Liaoning Province's rural serious illness insurance has the characteristics of large number of patients who are seriously ill and large expenditure. In 2016, the rural residents' serious illness insurance of the whole province compensated 105900 new rural cooperative patients. Under such a background, it is very difficult to balance the income and expenditure of the rural areas of Liaoning Province in the future of serious illness insurance, and the funds that receive or not offset will be difficult to sustain, and the sustainability of the implementation of the system will also not be guaranteed. It is necessary to measure the income and expenditure of Liaoning Province's future rural serious illness insurance, in order to achieve the goal of dynamic adjustment of the serious illness insurance system, to deal with the fund risks and challenges, so as to better meet the level of medical security needs of rural residents in Liaoning Province. This paper mainly includes five parts: the first part is the definition of related concepts and theoretical basis, the definition of serious illness and serious illness insurance related concepts, at the same time, select the relevant theory as the theoretical basis of this study; The second part is about the status quo and problems of rural serious illness insurance in Liaoning Province, discusses the current implementation of Liaoning Province rural serious illness insurance system, and discusses the related issues related to the income and expenditure of Liaoning Province rural serious illness insurance. The third part is the empirical analysis of the factors affecting the balance of income and expenditure of the rural major illness insurance in Liaoning Province, and explores the factors that affect the income and expenditure of the insurance fund of the rural major illness in Liaoning Province. The principal component analysis method is used to analyze the various indicators. Find out the main factors affecting the analysis; The fourth part is the calculation of the income and expenditure of the rural serious illness insurance fund in Liaoning Province. The model of income and expenditure of the serious illness insurance fund is set up to investigate the future income and expenditure of the serious illness insurance. Through forecasting the income and expenditure of the new rural cooperative fund in Liaoning province, this paper investigates whether the new rural cooperative fund has the ability to compensate the expenditure of the serious illness insurance and what influence the introduction of the serious illness insurance system has on the new rural cooperative fund. The sixth part is the conclusion and the countermeasure suggestion, according to the research conclusion and the explanation, puts forward the countermeasure and the suggestion to realize the Liaoning Province serious illness insurance income and expenditure balance problem.
【学位授予单位】：辽宁大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684;F323.89

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