S区大病补充医疗保险项目赔付控制对策研究
发布时间：2019-03-24 13:25
【摘要】：20世纪80年代以及90年代早期,我国社会医疗保险支出急剧增长,建立在基本医疗保险基础上的大病补充医疗保险项目赔付控制已经成为商业保险公司必须面临的课题。 本文以S区大病补充医疗保险项目赔付控制为研究对象,首先对影响国内外医疗费用增加因素：人口老龄化、医疗保险制度、国民收入的增加、医疗技术进步分别进行分析,通过对美国、英国、德国、新加坡等国家开展的社会医疗保险项目的启示,找出了S区大病补充医疗保险项目赔付控制中退休人员占比过高、账户结余过低、人均医疗赔付支出上涨过快等三大问题,提出了s区大病补充医疗保险项目赔付控制对策,通过建立市级统筹、对定点药店和医疗机构的管理、信息系统的建设、改变支付方式和手段等方式来保障S区大病补充医疗保险项目的安全运行。 本文通过对S区大病补充医疗保险项目赔付控制对策的研究,为商业保险公司的大病补充医疗保险项目赔付控制提供了可供参考的解决方案。
[Abstract]:In the 1980s and early 1990's, the expenditure of social medical insurance in our country increased rapidly. The compensation control of the major illness supplementary medical insurance project based on the basic medical insurance has become a subject that commercial insurance companies must face. This article takes the S area serious illness supplementary medical insurance item compensation control as the research object, first of all carries on the analysis to the influence domestic and foreign medical treatment expense increase factor: the population aging, the medical insurance system, the national income increase, the medical technology progress respectively, Through the inspiration to the social health insurance programs carried out in the United States, Britain, Germany, Singapore and other countries, it is found that the proportion of retirees and the low balance of accounts are too high and the balance of account is too low in the payment control of the supplemental medical insurance programs in the S region. Three major problems, such as the rapid increase of per capita medical compensation expenditure, have been put forward to control the compensation and payment of supplementary medical insurance items in s district. Through the establishment of municipal co-ordination, the management of designated drugstores and medical institutions, and the construction of information system, have been put forward. Change the way and means of payment to ensure the safe operation of the supplementary medical insurance project in S area. Based on the research on the compensation control strategy of the supplementary medical insurance project in S area, this paper provides a reference solution for the compensation control of the major illness supplementary medical insurance project in the commercial insurance company.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684
本文编号：2446363
[Abstract]:In the 1980s and early 1990's, the expenditure of social medical insurance in our country increased rapidly. The compensation control of the major illness supplementary medical insurance project based on the basic medical insurance has become a subject that commercial insurance companies must face. This article takes the S area serious illness supplementary medical insurance item compensation control as the research object, first of all carries on the analysis to the influence domestic and foreign medical treatment expense increase factor: the population aging, the medical insurance system, the national income increase, the medical technology progress respectively, Through the inspiration to the social health insurance programs carried out in the United States, Britain, Germany, Singapore and other countries, it is found that the proportion of retirees and the low balance of accounts are too high and the balance of account is too low in the payment control of the supplemental medical insurance programs in the S region. Three major problems, such as the rapid increase of per capita medical compensation expenditure, have been put forward to control the compensation and payment of supplementary medical insurance items in s district. Through the establishment of municipal co-ordination, the management of designated drugstores and medical institutions, and the construction of information system, have been put forward. Change the way and means of payment to ensure the safe operation of the supplementary medical insurance project in S area. Based on the research on the compensation control strategy of the supplementary medical insurance project in S area, this paper provides a reference solution for the compensation control of the major illness supplementary medical insurance project in the commercial insurance company.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684
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