完善长三角地区农村医疗保险制度研究

发布时间：2018-06-11 23:34

本文选题：长三角 + 农村医疗保险　；参考：《上海工程技术大学》2012年硕士论文

【摘要】：改革开放30年，特别是“十一五”期间，长三角地区医疗保险制度建设成绩斐然，覆盖城乡居民的医疗保障体系基本建立，但医疗保险制度城乡分割、医疗保险政策城乡不一、医疗保险待遇水平城乡悬殊等问题突出，在当今国家力行基本医疗保险制度城乡统筹发展的背景下,如何解决上述问题，实现医疗保险制度从“覆盖城乡”到“城乡一体化”的历史性跨越，建立城乡一体化的医疗保险制度,成为一个值得研究的课题。论文在医疗保险制度城乡一体化发展理论的指导下，详述长三角地区基本医疗保险的现状及实现条件,结合国内外社会医疗保险城乡一体化的经验模式，试探性的提出在经济发展水平相对较高的长三角地区突破农村医疗保险制度的发展瓶颈，先行建立城乡一体化的医疗保险制度。设计了四大实现方案：方案一,参保对象为所有城乡居民，筹资缴费上个人承担30%，，国家承担70%，补偿比例为门诊30%+住院50%。其他方案均在上一方案的基础上补偿比例依次提高10%。运用Spss软件从筹资和供给平衡的角度论证方案的可行性，主要测定人均筹资30%这一缴费额度是否在居民上年度收入的2%-3%这一承受缴费范围之内。70%的人均筹资额是否在政府财政支出的5%-7%范围之内。结果表明方案一、方案二在长三角地区目前是现实可行的，随着经济发展方案三、方案四也将逐步实现。城乡一体化的医疗保险制度设计意义重大：一方面，城乡一体化的医疗保险制度在政策设计上实现了城乡的连接贯通，在制度架构上实现了城乡统筹，在管理服务上实现城乡统一，在待遇标准上实现城乡基本一致，顺应了城乡经济社会一体化发展的大趋势。另一方面，城乡一体化的医疗保险制度有效规避了城乡医疗保险制度各自难以克服的缺陷，最大限度的实现了医疗保险制度的公平性，提高了制度运行的效率和互助共济能力，符合医疗保险制度自身发展的规律。
[Abstract]:During the 30 years of reform and opening up, especially during the "Eleventh Five-Year Plan" period, the construction of the medical insurance system in the Yangtze River Delta region has made great achievements, and the medical security system covering urban and rural residents has basically been established, but the medical insurance system is divided between urban and rural areas, and the medical insurance policy varies from city to country. The gap between urban and rural areas in the level of medical insurance benefits is outstanding. How to solve the above problems in the context of the overall development of the basic medical insurance system in urban and rural areas in the country today? To realize the historic leap of the medical insurance system from "covering urban and rural areas" to "urban-rural integration", and to establish a medical insurance system of urban-rural integration, Under the guidance of the development theory of urban and rural integration of medical insurance system, this paper describes the status quo and realization conditions of basic medical insurance in the Yangtze River Delta region. Combined with the experience of the integration of social medical insurance between urban and rural areas at home and abroad, this paper tentatively proposes to break through the bottleneck of the development of rural medical insurance system in the relatively high level of economic development of the Yangtze River Delta region. First, the establishment of urban and rural integration of medical insurance system. This paper designs four realization schemes: scheme 1, participating in insurance for all urban and rural residents, raising funds and paying fees for the individual to bear 30 points, the state bears 70%, and the proportion of compensation is 30% of the outpatients in hospital. The other schemes are on the basis of the previous program compensation ratio in turn increased by 10. Using SPSS software to prove the feasibility of the scheme from the point of view of financing and supply balance. It is mainly determined whether the payment amount of 30 percent per capita financing is within the range of 2.-3 percent of the residents' income last year, that is, .70 percent of the per capita amount of capital raised within the range of withstanding payment, whether it is within the range of 5-7 percent of the government's fiscal expenditure. The results show that the first and second schemes are realistic and feasible in the Yangtze River Delta region at present. With the economic development plan three, the fourth scheme will be gradually realized. The design of the urban-rural integrated medical insurance system is of great significance: on the one hand, The urban-rural integration of the medical insurance system in terms of policy design to achieve the link between urban and rural areas, in the framework of the system to achieve urban-rural integration, in the management of services to achieve urban-rural unity, in the standard of treatment of urban and rural basically consistent. In line with the development of urban and rural economic and social integration of the general trend. On the other hand, the urban-rural integrated medical insurance system effectively avoids the shortcomings of the urban and rural medical insurance system, realizes the fairness of the medical insurance system to the maximum extent, and improves the efficiency of the system operation and the ability of mutual aid. Accord with the law that medical treatment insurance system oneself develops.
【学位授予单位】：上海工程技术大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：C913.7

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