河北省城乡居民大病保险运行评价与策略研究

发布时间：2018-05-06 14:24

本文选题：城乡居民大病保险 + 信息传递　；参考：《河北大学》2017年硕士论文

【摘要】：城乡居民大病保险是社保与商业保险经营的结合,完善的城乡居民大病保险体系需要依靠健全的制度基础、科学的管理方法、先进的操作技术、严厉的惩戒措施,以及充足的资金。城乡居民大病保险不仅需要实现优化结算方式,制约道德风险,还应发展事前预防保健,严格事中监管控制,提升事后高效赔付,完善服务体系。本文通过实地调研所获取数据,分析河北省城乡居民大病保险的发展历程、补偿水平、经营水平,发现河北省城乡居民大病保险发展中存在道德风险频发、医保信息不对称、政策性风险及基金持续性等方面问题,分析得知这些问题的产生是由于城乡居民大病保险参与方的合作方式不当。在此基础上,分析城乡居民大病保险主要参与方间的合作关系及影响各自决策的因素,发现管理成本会影响城乡居民大病保险业务质量和经营,政府支持力度和适当的经济奖惩措施会影响城乡居民大病保险参与方的决策,这点在国内外先进城乡居民大病保险经营模式中也有所体现。最后总结先进城乡居民大病保险模式特点,并结合河北省城乡居民大病保险发展中的突出问题给出可行性建议,认为城乡居民大病保险业务前期应制定明确的招标标准、风险共担机制,在各机构之间建立通畅且完备的信息交流平台,实现信息的有效传递;中期加强医疗巡查,制约道德风险;在后期提供快速、及时的医疗赔付,并对业务发展做出准确评价,制定激励奖惩措施,以促进河北省城乡居民大病保险的健康持续发展。
[Abstract]:The serious illness insurance of urban and rural residents is a combination of social security and commercial insurance. A sound insurance system for urban and rural residents needs to rely on sound institutional basis, scientific management methods, advanced operational techniques, and severe disciplinary measures. And adequate funding. The urban and rural residents' serious illness insurance not only needs to optimize the settlement method, restrict the moral hazard, but also should develop the preventive health care beforehand, strictly supervise and control in the matter, promote the effective compensation after the event, perfect the service system. This paper analyzes the development process, compensation level and management level of the serious illness insurance of urban and rural residents in Hebei Province through the data obtained from field investigation. It is found that there are frequent moral risks and asymmetric medical insurance information in the development of the insurance for urban and rural residents in Hebei Province. Based on the analysis of policy risk and fund sustainability, it is found that these problems are due to the improper cooperation between urban and rural residents. On this basis, the paper analyzes the cooperative relationship between the main participants and the factors that affect their decision-making, and finds that the management cost will affect the quality and management of the insurance business of urban and rural residents. The government support strength and appropriate economic rewards and punishments will affect the decision of the participants of the urban and rural residents' serious illness insurance, which is also reflected in the advanced management mode of the urban and rural residents' serious illness insurance at home and abroad. Finally, this paper summarizes the characteristics of advanced urban and rural residents' serious illness insurance model, and puts forward some feasible suggestions in combination with the prominent problems in the development of Hebei Province's urban and rural residents' serious illness insurance, and thinks that the early stage of urban and rural residents' serious illness insurance business should formulate a clear bidding standard. Risk sharing mechanism to establish a smooth and complete information exchange platform among institutions to realize the effective transmission of information; to strengthen medical inspection in the medium term, to restrict moral hazard; to provide rapid and timely medical compensation in the later period, In order to promote the healthy and sustainable development of urban and rural residents insurance in Hebei Province, the author makes an accurate evaluation of the business development, and formulates incentives, rewards and punishment measures.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684

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