珠海市基本医疗保险制度的公平性研究

发布时间：2018-06-24 21:42

本文选题：城镇职工医疗保险 + 城乡居民医疗保险　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:我国已基本实现以城镇职工医疗保险制度、城镇居民医疗保险制度和新型农村合作医疗保险制度为主体的覆盖全民的基本医疗保障体系。虽然三种医疗保险制度的建立和全面实施在一定程度上解决了覆盖人群狭窄层面上的不公平问题,但由于三种医疗保险制度的设计定位、提出背景不同,在多年的独立运行之后,在筹资水平、补偿范围、补偿比例等方面的存在着较大差异,我国医疗保障体系在一定程度上很难达到真正的公平。因此,在解决了制度从无到有的不公平问题之后,我们应当更进一步的关注各项制度给相应人群提供的保障程度是否公平。否则,在"以收定支"的医疗保险基金筹集原则下,不同的制度差异容易被简单合理化,给不同制度下参保群体的收益公平性带来损害[1]。因此,统筹城乡居民医保,保障人人获得平等的医疗机会及相符的医疗待遇是医疗改革中需要关注的重点问题。本文将通过对珠海市不同医疗保险制度的研究,选取合理有效的医疗保险公平性评价指标和测量方法,探讨珠海市不同医疗保险制度下卫生服务利用公平性程度,为建立健全我国全民医疗保障体系提供一定的参考。方法:选取珠海市医疗保险制度作为研究对象。首先,根据研究对象实施城乡居民医疗保险制度的实际情况,结合专家建议,选取出具有普遍性、代表性的评价指标;其次,通过文献研究、查找相关数据资料,对珠海市2006年到2015年医疗保险基金收支进行泰尔指数分析,并对珠海市、佛山市和肇庆市进行公平性比较;最后,采用比较分析法对所收集的相关数据与资料进行分析研究,并对三市的筹资公平性和医疗服务利用公平性进行回归分析,得出结果,并对结果进行深入讨论研究。结果:通过对珠海市基本医疗保险制度的相关数据研究,得出珠海市基本医疗保险制度的筹资公平性和医疗服务利用公平性的泰尔指数逐年下降,表明其公平性逐步提高;从珠海市、佛山市和肇庆市的对比来看,佛山市的公平性最高,肇庆市的筹资公平性较好,珠海市的公平性平稳发展。同时,珠海市城镇职工医疗保险制度统筹基金结余情况较高,其累计结余的可支付水平达22.7个月,包含个人账户基金在内的职工医疗保险基金累计结余率为91.04%,城乡居民医疗保险基金结余情况良好。结论:首先,城乡居民医疗保险制度的待遇水平比较城镇职工医疗保险制度有待提高;再者,城镇职工医疗保险制度的统筹基金结余过多,结余可支付医疗保险费用几乎2年,基金池沉积过多,基金没能到有效利用。针对本文提出的基本医疗保险制度在社会医疗保险制度、医疗保险待遇水平和医疗保险基金这三方面的不公平提出了对策。提出了相应对策,从提高城乡居民医疗保险制度待遇、促进珠海市医疗保险制度一体化和提升基础医疗服务利用公平性来实现珠海市基本医疗保险制度的保障措施;加强对基本医疗保险基金的管理来,尤其是关注城镇职工医疗保险统筹基金的相关运行情况,建立健全基本医疗保险基金预警系统,加强基本医疗保险基金收支预算管理,提高统筹基金利用效率。通过更为有效地措施实施,以期最终实现基本医疗保险制度的公平性,为我国城乡医疗保险制度在"十三五"期间更好的发展提出了相关建议。
[Abstract]:Objective: China has basically realized the basic medical security system covering the medical insurance system of urban workers, the medical insurance system of urban residents and the new rural cooperative medical insurance system. Although the establishment and full implementation of the three kinds of medical insurance systems have solved the narrow level of the coverage of the population in a certain range. Fair problem, but because of the three kinds of medical insurance system design positioning, the background is different, after years of independent operation, in the financing level, compensation range, the proportion of compensation, and other aspects of the big difference, our medical security system is difficult to a certain extent to achieve real fairness. After the problem of inequality, we should pay more attention to the fairness of the system provided to the corresponding population. Otherwise, under the principle of collecting the medical insurance fund, different institutional differences are easy to be rationalized, and bring damage to the equity of the insured groups under different systems [1]., therefore, To raise the medical insurance of urban and rural residents, to ensure that everyone gets equal medical opportunities and to meet medical treatment is the key issue in the medical reform. This article will select a reasonable and effective evaluation index and measurement method of the fairness of medical insurance through the study of the different medical insurance system in Zhuhai, and discuss the different medical insurance system in Zhuhai. In order to provide a certain reference for the establishment and improvement of the national medical security system in China, the health care system in China is given a certain reference. Methods: the medical insurance system in Zhuhai is selected as the research object. First, according to the actual situation of the medical insurance system of urban and rural residents, the experts suggest that the medical insurance system is universal and representative. Secondly, through the literature study, searching for relevant data, the Zhuhai city from 2006 to 2015, the balance of the balance of medical insurance funds was analyzed, and the fairness of Zhuhai, Foshan and Zhaoqing was compared. Finally, the comparative analysis method was used to analyze the related data and data of the collected collection and to the three cities. The equity of financing and the use of fairness in medical services are analyzed, and the results are obtained. The results are discussed in depth. Results: through the study of the relevant data of the basic medical insurance system in Zhuhai, it is concluded that the equity of financing in the basic medical insurance system in Zhuhai and the equity index of the fair use of medical services are declining year by year. From the contrast of Zhuhai, Foshan and Zhaoqing, the equity of Foshan is the highest, the equity of Zhaoqing is fairly fair, the equity of Zhaoqing is fair, and the fair development of Zhuhai city is steady. At the same time, the balance of the medical insurance system of the urban workers in Zhuhai is high, and the total surplus can be paid up to 22.7. In the month, the cumulative surplus rate of the medical insurance fund, including the individual account fund, was 91.04%, and the balance of the medical insurance fund of the urban and rural residents was good. More than 2 years, the surplus can pay the medical insurance cost almost 2 years, the fund pool has been too much, the fund has not been able to make effective use. According to the basic medical insurance system proposed in this article in the social medical insurance system, the medical insurance treatment level and the medical insurance fund the three aspects of unfair countermeasures, put forward the corresponding countermeasures, from the improvement of urban and rural areas. The treatment of residents' medical insurance system, promote the integration of medical insurance system in Zhuhai and improve the basic medical service to realize the basic medical insurance system in Zhuhai; strengthen the management of the basic medical insurance fund, especially pay attention to the related operation of the medical insurance fund for urban workers and workers. We should improve the early warning system for the basic medical insurance fund, strengthen the budget management of the basic medical insurance fund and improve the utilization efficiency of the overall fund. Through more effective measures, the fairness of the basic medical insurance system is finally realized, and the related construction is put forward for the better development of the urban and rural medical insurance system during the "13th Five-Year" period. Argumentative.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

【参考文献】