我国基本医疗行政给付研究

发布时间：2018-04-19 08:35

本文选题：医疗保险 + 政府责任　；参考：《湖南工业大学》2017年硕士论文

【摘要】：基本医疗行政给付是行政给付在医疗保障领域的具体化。基本医疗行政给付是指行政机关在基本医疗领域应该给予符合条件的公民一定物质或者服务帮助的行为,其具有给付主体是具有特殊职能的特定机关、给付标的相对确定、给付对象范围广泛以及给付方式较为固定等有别于传统行政给付的基本特征。基本医疗行政给付具有深厚的法理基础,主要包括权利基础和规范依据。基本医疗行政给付的权利基础除了宪法上的生存权、平等权和健康权以外,还包括医疗资源公平分配权、请求医疗照顾权利、紧急救治权利和医疗保险权等具体权利。另外,基本医疗行政给付还具有多层级的规范依据,具体包括宪法上的相关规定、一系列法律法规的规定以及许多规范性文件的内容。目前,我国基本医疗行政给付大致有基本医疗保险给付和基本医疗救助给付两部分构成。前者主要包括城镇职工基本医疗保险、新型农村合作医疗和城镇居民基本医疗保险;后者根据《社会救助暂行办法》的规定,主要内容包括医疗救助目标、医疗救助对象、医疗救助方式、医疗救助标准、医疗救助申办程序以及应急医疗救助等。无论是基本医疗保险给付和基本医疗救助给付其在运行的过程中都存在一定的问题,其中基本医疗保险给付存在城乡保险给付标准不统一且差别较大、给付缺少专门立法且保障性不足、给付主体责任分配不科学以及给付基金监管失范等问题,而基本医疗救助给付则存在立法层级较低、管理体制不健全、给付资金绝对不足和相对过剩的矛盾以及城乡医疗救助制度存在明显差异,农村医疗救助给付问题突出等突出问题。从世界范围来看,其他国家的基本医疗行政给付制度对我国有一定的借鉴意义。其中在基本医疗保险给付领域,国家医疗保险的英国模式、社会医疗保险型的德国模式、市场主导型的美国保险模式等都存在国家给付的色彩,而域外基本医疗救助给付除了英国、美国之外,其他国家也都强调国家在给付中的重要作用,并且对行政给付的标准、程序等都做了相应规定。通过以上借鉴,可以通过构建城乡一体的全民基本医疗行政给付制度;形成以宪法为统摄的基本医疗行政给付法律体系;提高行政机关基本医疗行政给付的执行能力;开拓公民基本医疗行政给付的多元救济渠道等手段完善我国基本医疗行政给付制度。
[Abstract]:Basic medical administrative payment is the embodiment of administrative payment in the field of medical security.Administrative payment of basic medical treatment refers to the act that an administrative organ should give certain material or service assistance to eligible citizens in the field of basic medical treatment, the subject of which is a specific organ with special functions, and the object of payment is relatively determined.The basic characteristics of payment are different from the traditional administrative payment, such as the wide range of objects and the fixed mode of payment.The basic medical administrative payment has a deep legal basis, mainly including the right basis and the normative basis.In addition to the constitutional rights of survival, equality and health, the right to pay for basic medical administration includes the right to fair distribution of medical resources, the right to request medical care, the right to emergency treatment and the right to medical insurance.In addition, the basic medical administrative payment has a multi-level normative basis, including the relevant provisions of the Constitution, a series of laws and regulations, as well as the content of many normative documents.At present, China's basic medical administrative payment consists of two parts: basic medical insurance payment and basic medical relief payment.The former mainly includes the basic medical insurance for urban workers, the new rural cooperative medical care scheme and the basic medical insurance for urban residents; the latter includes medical assistance objectives and medical assistance objects in accordance with the provisions of the interim measures on Social Assistance.Medical aid method, medical aid standard, medical aid application procedure and emergency medical aid, etc.There are some problems in the operation of basic medical insurance payment and basic medical assistance payment, among which the standard of urban and rural insurance payment is not uniform and there is a big difference between the basic medical insurance payment and the basic medical assistance payment.Due to the lack of special legislation and insufficient security, the unscientific distribution of the responsibility of the main body of the payment and the improper supervision of the payment fund, the basic medical assistance payment has a lower legislative level and an imperfect management system.There are obvious differences between urban and rural medical aid system, and the problems of rural medical aid payment are prominent.From the point of view of the world, the basic medical administrative payment system of other countries has certain reference significance to our country.Among them, in the field of basic medical insurance payment, the British model of national medical insurance, the German model of social medical insurance and the market-oriented American insurance model all have the color of state payment.In addition to the United Kingdom and the United States, other countries also emphasize the important role of the state in the payment of basic medical assistance, and make corresponding provisions on the standard and procedure of administrative payment.Through the above reference, we can construct the basic medical administrative payment system of the whole people, form the legal system of the basic medical administrative payment based on the constitution, improve the executive ability of the basic medical administrative payment of the administrative organ.Open up multiple relief channels for citizens' basic medical administrative payment and improve our basic medical administrative payment system.
【学位授予单位】：湖南工业大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D922.16

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