本文選題：大病保險(xiǎn)　切入點(diǎn)：良性機(jī)制　出處：《湖南師范大學(xué)》2014年碩士論文

【摘要】：我國(guó)的醫(yī)療保障體系歷經(jīng)十多年的改革與發(fā)展,取得了十分突出的成績(jī)。以基本醫(yī)療保障為主體、其他多種形式補(bǔ)充的醫(yī)療保險(xiǎn),以及商業(yè)保險(xiǎn)為補(bǔ)充、覆蓋城鄉(xiāng)居民的多層次醫(yī)療保障體系已初步建立,但總體上來(lái)說(shuō),保障制度和保障水平還較低,抵御大病風(fēng)險(xiǎn)的能力不強(qiáng),個(gè)人大病醫(yī)療費(fèi)用負(fù)擔(dān)仍然很重,迫切需要建立重特大疾病保障機(jī)制。 2012年8月,國(guó)家發(fā)展改革委、衛(wèi)生部、財(cái)政部、人力資源社會(huì)保障部、民政部、保監(jiān)會(huì)六個(gè)部門(mén)聯(lián)合發(fā)布《關(guān)于開(kāi)展城鄉(xiāng)居民大病保險(xiǎn)工作的指導(dǎo)意見(jiàn)》,這一意見(jiàn)的發(fā)布意味著我國(guó)醫(yī)療保障水平的進(jìn)一步提升。隨著新政策的實(shí)施,看病難、看病貴的問(wèn)題得到一定程度上的緩解,大病保險(xiǎn)作為一項(xiàng)創(chuàng)新性實(shí)施項(xiàng)目,在政策運(yùn)行過(guò)程中,還存在著較多的問(wèn)題,其良性機(jī)制的構(gòu)建有助于大病政策效用的發(fā)揮。 本研究從籌資機(jī)制、保障內(nèi)容、承辦方式三方面分析了大病保險(xiǎn)制度設(shè)計(jì)的合理性,并在此基礎(chǔ)上,以湖南省試點(diǎn)城市——郴州為調(diào)查地點(diǎn)進(jìn)行實(shí)踐調(diào)研,總結(jié)了大病保險(xiǎn)的發(fā)展?fàn)顩r,分析了大病保險(xiǎn)的難點(diǎn)、重點(diǎn)所在：政策宣傳、保險(xiǎn)賠付、統(tǒng)籌監(jiān)管、醫(yī)療費(fèi)用等問(wèn)題,提出了合理的可行性建議：建立合理籌資機(jī)制、風(fēng)險(xiǎn)聯(lián)動(dòng)機(jī)制,明確雙方責(zé)任,完善商業(yè)保險(xiǎn)公司參與大病保險(xiǎn)的機(jī)制設(shè)計(jì),利用稅收激勵(lì),提高保險(xiǎn)公司參與積極性,一體化管理等。試圖探索出大病保險(xiǎn)的良性機(jī)制,為大病保險(xiǎn)項(xiàng)目持續(xù)穩(wěn)定的發(fā)展保駕護(hù)航。
[Abstract]:After more than a decade of reform and development, China's medical security system has made outstanding achievements. With basic medical security as the main body, other forms of supplementary medical insurance, as well as commercial insurance, A multi-level medical security system covering urban and rural residents has been initially established, but on the whole, the security system and security level are still relatively low, the ability to resist the risk of serious illness is not strong, and the burden of individual medical expenses for serious illness is still very heavy. There is an urgent need to establish a major disease protection mechanism. In August 2012, the National Development and Reform Commission, the Ministry of Health, the Ministry of Finance, the Ministry of Human Resources and Social Security, the Ministry of Civil Affairs, The CIRC's six departments jointly issued a "guidance opinion on the Development of Major illness Insurance for Urban and Rural residents." the release of this opinion means that the level of medical security in China has been further improved. With the implementation of the new policy, it is difficult to see a doctor. The problem of expensive medical treatment has been alleviated to a certain extent. As an innovative implementation project, there are still many problems in the process of policy operation. This study analyzes the rationality of the design of the serious illness insurance system from three aspects of the financing mechanism, the content of the guarantee and the way of undertaking, and on this basis, taking Chenzhou, the pilot city of Hunan Province, as the investigation site, carries on the practice investigation. This paper summarizes the development of the serious illness insurance, analyzes on the difficulties of the serious illness insurance, focuses on the following problems: policy propaganda, insurance indemnity, overall supervision, medical expenses, and so on, and puts forward some reasonable feasible suggestions: establishing reasonable financing mechanism, The mechanism of risk linkage, clarifying the responsibilities of both sides, perfecting the mechanism design of commercial insurance companies to participate in the insurance of serious illness, utilizing tax incentives, improving the participation enthusiasm of insurance companies and integrating management, etc., attempts to explore the benign mechanism of serious illness insurance. To ensure the sustained and stable development of the major illness insurance program.
【學(xué)位授予單位】：湖南師范大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：F842.684;R197.1

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