晋江市城镇职工基本医疗保险费用控制研究

发布时间：2018-03-10 03:07

本文选题：城镇职工基本医疗保险　切入点：费用控制　出处：《华侨大学》2017年硕士论文　论文类型：学位论文

【摘要】：随着社会的不断发展和进步,人们的医疗保健意识不断增强,各种医疗保险应运而生。医疗保险是为补偿治疗疾病所产生费用的一种保险。城镇职工基本医疗保险是由用人单位和个人共同缴费建立保险基金,参保人员患病就诊产生治疗费用后,保险经办机构负责给予其一定经济补偿,以减轻参保人员的经济负担。城镇职工基本医疗保险制度是一种补偿城镇职工因治疗疾病所产生经济损失的社会医疗保险制度,是我国社会保障体系的一个重要组成部分,有效降低了参保人员的患病治疗的经济压力,对促进社会主义和谐社会建设发挥了积极作用。随着参保人数的不断增多以及人们健康意识在逐渐增强,城镇职工基本医疗保险支出费用增速过快的问题凸显,必须有效采取措施,不断完善城镇职工基本医疗保险相关制度,控制医疗保险费用的增速,从而确保我国的这一基本医疗保险制度的顺利发展。本文将大数法则、博弈论、道德风险理论和控制论等理论引入城镇职工基本医疗保险费用的控制研究中,在分析晋江市的城镇职工基本医疗保险费用控制现状后,认为晋江市城镇职工基本医疗保险费用控制主要存在住院医疗费用增长过快、药品费用占医疗费用比例过大、患者就医行为缺乏约束、自付比例设置不科学、医疗保险结算制度不合理和医疗保险费用支出监测体系不健全等问题。同时,本文通过查阅文献,分别以世界上最早建立社会保障制度的德国、发达国家里唯一一个不实行全民医疗保险的美国和实行国家医疗保险全面覆盖的英国等三个西方国家以及上海、镇江和青岛等国内典型城市为研究对象,学习借鉴国内外先进医疗保险费用控制经验。最后,本文结合晋江市的实际情况,分别从医疗服务供给方(主要针对医保定点医院)、医疗服务需求方(参保患者)、医疗保险经办机构(晋江市医保中心)及加强政府职能和作用等四方面提出构建适合的医疗保险费用支付方式、科学控制支付比例、完善医疗服务信息发布机制等措施,希望可以对控制晋江市医疗保险费用的增长发挥作用,并为国内其它城市城镇职工基本医疗保险费用控制提供参考。
[Abstract]:With the continuous development and progress of the society, people's awareness of medical care has been increasing. Various medical insurance arises at the historic moment. Medical insurance is a kind of insurance to compensate for the expenses caused by the treatment of diseases. The basic medical insurance for urban workers is set up by the joint payment of employers and individuals. The insurance agency shall be responsible for providing certain economic compensation to the insured persons after the medical treatment of the insured person has incurred treatment expenses. The basic medical insurance system for urban workers is a social medical insurance system that compensates for the economic losses caused by the treatment of diseases among urban workers, and is an important part of the social security system of our country. It has effectively reduced the economic pressure of medical treatment for insured personnel and played a positive role in promoting the construction of a harmonious socialist society. With the increasing number of insured persons and the increasing awareness of people's health, The problem of the excessive increase in the expenditure on basic medical insurance for urban workers has been highlighted. It is necessary to take effective measures to continuously improve the relevant system of basic medical insurance for urban workers and to control the growth of medical insurance expenses. In order to ensure the smooth development of the basic medical insurance system in China, this paper introduces the large number theory, game theory, moral hazard theory and cybernetics into the study of the control of the basic medical insurance costs of urban workers. After analyzing the current situation of the cost control of basic medical insurance for urban workers in Jinjiang City, it is concluded that the cost control of basic medical insurance for urban workers in Jinjiang City is mainly due to the excessive growth of hospitalization medical expenses and the excessive proportion of drug expenses to medical expenses. There are some problems such as the lack of restraint of patients' behavior to seek medical treatment, the unscientific setting of out-of-pocket ratio, the unreasonable system of medical insurance settlement and the unsound monitoring system of medical insurance expenses. At the same time, this paper refers to the literature, Respectively, Germany, the first country in the world to establish a social security system, the only developed country in the world, the United States, which does not implement universal medical insurance, and the United Kingdom, which has comprehensive coverage of national medical insurance, and Shanghai, Zhenjiang and Qingdao and other typical domestic cities as the research object, learn from the advanced medical insurance cost control experience at home and abroad. Finally, this paper combined with the actual situation of Jinjiang City, Respectively from four aspects of medical service provider (mainly aimed at the designated hospital of medical insurance, the demand side of medical service (insured patients), medical insurance agency (Jinjiang Medical Insurance Center) and strengthening the functions and functions of the government. Appropriate method of payment of medical insurance expenses, It is hoped that the measures such as scientifically controlling the proportion of payment and perfecting the mechanism of issuing medical service information can play a role in controlling the increase of medical insurance costs in Jinjiang and provide a reference for the control of basic medical insurance costs for urban workers in other cities and towns in China.
【学位授予单位】：华侨大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

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