我国大病保险制度建设研究

发布时间：2018-12-11 21:38

【摘要】：在我国经济社会日益发达的今天,人民群众对于个人健康生活的诉求不断提高,然而我国现有的基本医疗保险的覆盖范围和保障水平相对有限。对于罹患重大疾病的人民群众,自身往往需要负担较大比例的医疗费用,因病致贫和返贫现象时有发生。这违背了我国到2020年解决贫困问题和全面建成小康社会的总体部署。在此背景下,我国于2012年开始全面推进大病保险制度的相关建设,目前已在全国所有省区和直辖市开展试点,且部分地区已经全面铺开相关工作。但在实际操作中,缺乏相关理论指导,存在诸多问题,需要尽快研究解决。基于以上原因,本文对我国的大病保险制度进行了全面研究:首先梳理了现有的相关文献;在此基础上,对我国的基本医疗保障体系和大病的概念作出界定,并从运行模式、筹资机制、保障水平、承保方式和监督管控五方面对我国大病保险制度做了论述,着重使用准公共产品理论、福利多元主义理论、公共外包理论和公共选择理论对我国的大病保险制度进行经济学属性分析;接着介绍了国内地区(湛江市、太仓市和厦门市)的大病保险制度实施背景和实施效果,从政策制定、筹资方式和保障效果等方面对其优势和不足进行分析;然后将国外医疗保险模式分为社会医疗保险模式、国家健康保险模式、储蓄医疗保险模式和商业医疗保险模式四种,并以德国、英国、新加坡和美国作为代表进行了阐述,分析其运行模式和优缺点;最后,对完善我国的大病保险制度提出了六点政策建议,分别是建立多渠道的动态筹资机制、构建大病保险信息服务平台、完善政企风险公担机制、加速医药卫生领域改革进程和增强居民预防保健意识。
[Abstract]:With the development of our country's economy and society, the people's demands for a healthy personal life are increasing. However, the coverage and security level of the existing basic medical insurance are relatively limited in our country. For the people suffering from major diseases, they often have to bear a large proportion of medical expenses, and the phenomenon of poverty and return to poverty occur from time to time. This runs counter to the overall plan of solving the poverty problem and building a well-off society in an all-round way by 2020. In this context, in 2012, China began to comprehensively promote the serious illness insurance system related to the construction, has been in all provinces and municipalities in the country to pilot, and some areas have been fully spread out the relevant work. However, in practice, there are many problems in the lack of theoretical guidance, which need to be solved as soon as possible. Based on the above reasons, this paper has carried on the comprehensive research to our country's serious illness insurance system: firstly, has combed the existing related literature; On this basis, the basic medical security system and the concept of serious illness in China are defined, and the insurance system of our country is discussed from five aspects: the operating mode, the financing mechanism, the level of security, the way of underwriting, the supervision and control. This paper focuses on the use of quasi-public product theory, welfare pluralism theory, public outsourcing theory and public choice theory to analyze the economic attributes of China's serious illness insurance system. Then it introduces the background and effect of the serious illness insurance system in China (Zhanjiang City, Taicang City and Xiamen City), and analyzes its advantages and disadvantages from the aspects of policy formulation, financing method and guarantee effect. Then the foreign medical insurance model is divided into social medical insurance model, national health insurance model, savings medical insurance model and commercial medical insurance model, which are represented by Germany, Britain, Singapore and the United States. Analyze its operation mode, advantages and disadvantages; Finally, six policy suggestions are put forward to perfect our country's serious illness insurance system, which are to establish a multi-channel dynamic financing mechanism, to construct a platform of information service for serious illness insurance, and to perfect the mechanism of government and enterprise risk sharing. We will speed up the reform process in the field of medicine and health care and enhance the awareness of prevention and health care among the residents.
【学位授予单位】：广西大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684

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