吉林省医疗保险城乡一体化的可行性研究

发布时间：2019-06-05 13:06

【摘要】：目的：通过对吉林省医保体系的历史发展和现状进行调查、分析，结合吉林省的实际情况，参考国际上的先进经验和国内其它省市试点的经验，探索适合我省实际情况的医保城乡统筹的机制。方法：本研究通过文献研究法、访谈法等方法对吉林省医疗保险体系现状进行调查研究，采用描述性分析、秩和检验等统计方法对肺癌患者数据、2007-2012年吉林省新农合患者在不同级别医疗机构就医的数据进行处理，采取文献研究法和非结构型访谈法对长春市朝阳区的试点情况进行研究。结果：城镇职工医疗保险的各方面待遇远高于其它医保。城镇居民医疗保险和新农合在总费用、住院天数、自费费用、自费比例、报销费用、报销比例等方面比较接近，无显著差异。城乡统筹试点的朝阳区为新农合患者的医疗与报销提供了方便，但是降低了患者的待遇。2007-2012年，吉林省新农合患者在各级医疗机构就医时，住院次均费用、住院次均自费费用、补偿比例逐年提升。在基层医疗机构就医的患者逐年减少，到县级及县级以上医疗机构就医的患者逐年增多。基层医疗机构在医保基金中所占的份额逐年递减，县级医疗机构所占份额逐年上升，县以上医疗机构所占份额基本保持不变。结论：实施医保城乡统筹，可以解决省内流动人口医保关系的转移接续问题；可以缩短城乡差距，，体现公共服务均等化的理念；可以加强对医保基金的监管和对骗保行为的打击力度；可以扩大省内各统筹地区的医保基金规模。
[Abstract]:Objective: through the investigation and analysis of the historical development and present situation of the medical insurance system in Jilin Province, combined with the actual situation of Jilin Province, referring to the advanced international experience and the experience of other provinces and cities in China, Explore the medical insurance urban and rural overall planning mechanism suitable for the actual situation of our province. Methods: this study investigated the present situation of medical insurance system in Jilin Province by means of literature research and interview, and used descriptive analysis, rank sum test and other statistical methods to analyze the data of patients with lung cancer. From 2007 to 2012, the data of NCMS patients in different levels of medical institutions in Jilin Province were processed, and the pilot situation of Chaoyang District of Changchun City was studied by means of literature research and unstructured interview. Results: the treatment of medical insurance for urban workers was much higher than that of other medical insurance. There is no significant difference between urban residents' medical insurance and NCMS in terms of total expenses, hospitalization days, self-expenses, proportion of self-expenses, reimbursement ratio and so on. Chaoyang District, which is a pilot project in urban and rural areas, provides convenience for the medical treatment and reimbursement of NCMS patients, but reduces the treatment of patients. From 2007 to 2012, the average cost of hospitalization of NCMS patients in medical institutions at all levels in Jilin Province was average. Hospitalization expenses are all at their own expense, and the proportion of compensation is increasing year by year. The number of patients seeking medical treatment in primary medical institutions is decreasing year by year, and the number of patients going to county-level and above medical institutions is increasing year by year. The share of primary medical institutions in medical insurance funds is decreasing year by year, the share of county-level medical institutions is increasing year by year, and the share of medical institutions above county level is basically unchanged. Conclusion: the implementation of medical insurance as a whole between urban and rural areas can solve the problem of transferring and continuing the relationship of medical insurance for floating population in the province, shorten the gap between urban and rural areas, and embody the concept of equal public service. It can strengthen the supervision of health insurance funds and crack down on insurance fraud, and can expand the scale of health insurance funds in all areas of the province.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.1;F842.684

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