大病医保体系中商业医疗保险和社会医疗保险的衔接研究
发布时间：2019-06-10 04:56
【摘要】：医疗保险是社会保险的重要组成部分，维系着人民群众最基本的社会保障需求。新医改以来，我国医疗保险体系不断改革深化，但是总体上看仍然存在资金使用效率有待提高、保障范围仍有死角、保障水平参差不齐等问题，特别是对于城镇居民保险和新农合的群体，往往在罹患大病的时候，面临着因病致贫，因病返贫的经济风险。费用配置、制度设计和风险控制等方面的矛盾在大病医保体系中表现的尤为突出。商业医疗保险和社会医疗保险的衔接是解决这一矛盾的有效途径。大病医保体系中商业医疗保险和社会医疗保险的衔接研究对于建立多层次医疗保障制度、切实提高医疗保障水平、推动公共卫生事业发展有着非常重要的作用。 本文提出了大病医保体系中商业医疗保险和社会医疗保险的衔接问题，首先界定了相关概念，从大病医保的基本属性出发，分析了大病医保体系中政府和市场的相关作用，对比了商业医疗保险和社会医疗保险的联系和区别，分析了两者在大病医保体系中的定位关系、衔接关系和相互之间关系的转变。本文主要立足于公共政策分析的角度，综合运用了保险学和经济学的经典方法，阐明了在大病医保体系中商业医疗保险和社会医疗保险相互衔接的必要性和可行性。 衔接研究的第二步分析了我国大病医保制度建立的背景和基本内容，以及当前商业医疗保险和社会医疗保险衔接的现状，，着重分析了湛江和太仓两地的模式。指出了当前状况下大病医保体系中商业医疗保险和社会医疗保险衔接过程中存在的缺陷，提出了两者衔接过程中的三个关键点：资金筹集和给付的衔接、保障范围的衔接和保障对象的衔接。 最后是对大病医保体系中商业医疗保险和社会医疗保险的衔接对策进行了研究分析。以上海市为例，设计了大病医保体系中商业医疗保险和社会医疗保险衔接的方案，并提出了两者衔接过程需要的内部制度保证和外部激励条件。 本文通过对商业医疗保险和社会医疗保险的衔接研究，从理论上解释了大病医保体系中商业医疗保险和社会医疗保险衔接的必要性、可行性，明确了两者的定位和关系，给出了具体的衔接思路和简单的衔接模型，为大病医保体系下一步学术上的深入研究，乃至其中商业保险和社会保险衔接在政策上的实施推进，提供了一种可以借鉴的思路。
[Abstract]:Medical insurance is an important part of social insurance, which maintains the most basic social security needs of the people. Since the new medical reform, the medical insurance system in our country has been continuously reformed and deepened, but on the whole, there are still some problems, such as the efficiency of the use of funds needs to be improved, the scope of security is still dead, and the level of security is uneven. Especially for urban residents insurance and NCMS groups, they are often faced with the economic risk of poverty caused by illness and returning to poverty because of illness. The contradiction of cost allocation, system design and risk control is particularly prominent in the serious illness medical insurance system. The connection between commercial medical insurance and social medical insurance is an effective way to solve this contradiction. The study of the connection between commercial medical insurance and social medical insurance in the medical insurance system of serious illness plays a very important role in establishing a multi-level medical security system, effectively improving the level of medical security and promoting the development of public health undertakings. This paper puts forward the connection between commercial medical insurance and social medical insurance in the serious illness medical insurance system, first defines the related concepts, and analyzes the related functions of the government and the market in the serious illness medical insurance system from the basic attributes of the serious illness medical insurance. This paper compares the relationship and difference between commercial medical insurance and social medical insurance, and analyzes the positioning relationship, cohesion relationship and the transformation of the relationship between them in the serious illness medical insurance system. Based on the point of view of public policy analysis, this paper comprehensively uses the classical methods of insurance and economics, and expounds the necessity and feasibility of the connection between commercial medical insurance and social medical insurance in the serious illness medical insurance system. The second step of the cohesion study analyzes the background and basic contents of the establishment of the serious illness medical insurance system in China, as well as the current situation of the connection between commercial medical insurance and social medical insurance, with emphasis on the model of Zhanjiang and Taicang. This paper points out the defects existing in the connection process between commercial medical insurance and social medical insurance in the medical insurance system of serious illness under the current situation, and puts forward three key points in the process of connection between the two: the connection between fund raising and payment. The connection of the scope of guarantee and the connection of the object of guarantee. Finally, the paper studies and analyzes the countermeasures of commercial medical insurance and social medical insurance in the medical insurance system of serious illness. Taking Shanghai as an example, this paper designs the scheme of connecting commercial medical insurance with social medical insurance in the medical insurance system of serious illness, and puts forward the internal system guarantee and external incentive conditions needed in the process of connection between the two. Through the study of the connection between commercial medical insurance and social medical insurance, this paper theoretically explains the necessity and feasibility of the connection between commercial medical insurance and social medical insurance in the serious illness medical insurance system, and clarifies the orientation and relationship between the two. This paper gives the concrete connection train of thought and the simple connection model, which provides a kind of train of thought that can be used for reference for the further academic research of the medical insurance system for serious illness, and even for the implementation of the policy of the connection between commercial insurance and social insurance.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684
本文编号：2496185
[Abstract]:Medical insurance is an important part of social insurance, which maintains the most basic social security needs of the people. Since the new medical reform, the medical insurance system in our country has been continuously reformed and deepened, but on the whole, there are still some problems, such as the efficiency of the use of funds needs to be improved, the scope of security is still dead, and the level of security is uneven. Especially for urban residents insurance and NCMS groups, they are often faced with the economic risk of poverty caused by illness and returning to poverty because of illness. The contradiction of cost allocation, system design and risk control is particularly prominent in the serious illness medical insurance system. The connection between commercial medical insurance and social medical insurance is an effective way to solve this contradiction. The study of the connection between commercial medical insurance and social medical insurance in the medical insurance system of serious illness plays a very important role in establishing a multi-level medical security system, effectively improving the level of medical security and promoting the development of public health undertakings. This paper puts forward the connection between commercial medical insurance and social medical insurance in the serious illness medical insurance system, first defines the related concepts, and analyzes the related functions of the government and the market in the serious illness medical insurance system from the basic attributes of the serious illness medical insurance. This paper compares the relationship and difference between commercial medical insurance and social medical insurance, and analyzes the positioning relationship, cohesion relationship and the transformation of the relationship between them in the serious illness medical insurance system. Based on the point of view of public policy analysis, this paper comprehensively uses the classical methods of insurance and economics, and expounds the necessity and feasibility of the connection between commercial medical insurance and social medical insurance in the serious illness medical insurance system. The second step of the cohesion study analyzes the background and basic contents of the establishment of the serious illness medical insurance system in China, as well as the current situation of the connection between commercial medical insurance and social medical insurance, with emphasis on the model of Zhanjiang and Taicang. This paper points out the defects existing in the connection process between commercial medical insurance and social medical insurance in the medical insurance system of serious illness under the current situation, and puts forward three key points in the process of connection between the two: the connection between fund raising and payment. The connection of the scope of guarantee and the connection of the object of guarantee. Finally, the paper studies and analyzes the countermeasures of commercial medical insurance and social medical insurance in the medical insurance system of serious illness. Taking Shanghai as an example, this paper designs the scheme of connecting commercial medical insurance with social medical insurance in the medical insurance system of serious illness, and puts forward the internal system guarantee and external incentive conditions needed in the process of connection between the two. Through the study of the connection between commercial medical insurance and social medical insurance, this paper theoretically explains the necessity and feasibility of the connection between commercial medical insurance and social medical insurance in the serious illness medical insurance system, and clarifies the orientation and relationship between the two. This paper gives the concrete connection train of thought and the simple connection model, which provides a kind of train of thought that can be used for reference for the further academic research of the medical insurance system for serious illness, and even for the implementation of the policy of the connection between commercial insurance and social insurance.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684
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