本文選題：兒童 + 醫(yī)療保險(xiǎn)��； 參考：《西南財(cái)經(jīng)大學(xué)》2013年碩士論文

【摘要】：我國現(xiàn)有3.67億(近4億)的少年兒童,他們當(dāng)前基本上處于醫(yī)療保障水平低或無醫(yī)療保障狀態(tài),其中數(shù)量達(dá)到2.6億的介于0到6歲間的兒童,他們沒有任何醫(yī)療保險(xiǎn),且每年以1200萬的數(shù)量在增加。而有關(guān)資料顯示,我國5歲以下的兒童,其死亡人數(shù)每年居然達(dá)到40萬,由于無法獲得及時(shí)治療而造成死亡的人數(shù),數(shù)量甚至達(dá)到了24萬之高,換句話說,每年死亡的孩子中,本有60%孩子原可免于死亡,這個(gè)數(shù)字的巨大足以引起我們的反思。我國兒童商業(yè)醫(yī)療保險(xiǎn)仍然是商業(yè)醫(yī)療保險(xiǎn)的薄弱環(huán)節(jié),特別是兒童易發(fā)重大疾病救治得不到足夠的經(jīng)濟(jì)上的支持和補(bǔ)償,發(fā)展我國商業(yè)兒童醫(yī)療保險(xiǎn)勢在必行。這里將從我國兒童醫(yī)療保險(xiǎn)保障現(xiàn)狀及問題入手,首先分析我國兒童社會(huì)醫(yī)療保險(xiǎn)情況,同時(shí)加入對我國商業(yè)兒童醫(yī)療保險(xiǎn)存在缺陷的考慮,并指出我國政府對兒童商業(yè)醫(yī)療險(xiǎn)支持疲軟,得出要發(fā)展我國兒童商業(yè)醫(yī)療保險(xiǎn)的結(jié)論。然后再對我國兒童商業(yè)醫(yī)療保險(xiǎn)發(fā)展困難的原因進(jìn)行討論。最終,分析我國兒童商業(yè)醫(yī)療保險(xiǎn)消費(fèi)者市場需求狀況,并為商業(yè)兒童醫(yī)療保險(xiǎn)從政府行業(yè)組織、保險(xiǎn)公司以及消費(fèi)者角度,給出相應(yīng)的發(fā)展建議。 本文內(nèi)容分為四個(gè)部分：第一部分是緒論部分：主要闡述了選題的研究背景及意義,并對研究目的和方法做了簡要提及。 第二部分全面描述醫(yī)療保險(xiǎn),點(diǎn)出醫(yī)療保險(xiǎn)的特點(diǎn)。對兒童醫(yī)療保險(xiǎn)被保險(xiǎn)人做出界定,闡述兒童醫(yī)療險(xiǎn)區(qū)別于成人險(xiǎn)的特別之處,并進(jìn)行深入分析,使讀者掌握決定兒童醫(yī)療險(xiǎn)需求的因素和兒童疾病意外風(fēng)險(xiǎn)的特征。最終闡明發(fā)展商業(yè)兒童醫(yī)療保險(xiǎn)的意義。 第三部分是我國兒童醫(yī)療保險(xiǎn)現(xiàn)狀問題及成因：此章節(jié)的目的是為了說明發(fā)展兒童商業(yè)醫(yī)療保險(xiǎn)的必要性,從社會(huì)保險(xiǎn)和商業(yè)保險(xiǎn)兩個(gè)方向出發(fā)闡明我國兒童醫(yī)療保險(xiǎn)現(xiàn)狀問題。 文章先闡述了我國兒童醫(yī)療保障在社會(huì)保險(xiǎn)領(lǐng)域的表現(xiàn)。首先,我國兒童社會(huì)醫(yī)療保險(xiǎn)普及度仍然不高,城鎮(zhèn)兒童社會(huì)醫(yī)保普及度比農(nóng)村兒童還要低。再來就是,已建立兒童社會(huì)醫(yī)保制度的地區(qū)為兒童提供的醫(yī)療保障水平低。綜合可得出結(jié)論,我國的兒童基本醫(yī)療保障體系不能提供能夠基本上滿足兒童醫(yī)療保障需求的服務(wù)。 接著又表述了我國兒童商業(yè)醫(yī)療保險(xiǎn)現(xiàn)狀問題。我國商業(yè)保險(xiǎn)市場上的兒童醫(yī)療保險(xiǎn)產(chǎn)品雖然數(shù)量繁多,但險(xiǎn)種種類偏少,且現(xiàn)有的幾種中同質(zhì)性問題和保障不足的問題同樣存在。 章節(jié)的最后部分給出我國兒童商業(yè)醫(yī)療保險(xiǎn)發(fā)展不如人意的原因,究其原因主要包括： (一)保險(xiǎn)公司方面。兒童醫(yī)療保險(xiǎn)在設(shè)計(jì)之初就已經(jīng)偏離了市場的需求,這是由保險(xiǎn)產(chǎn)品的特殊性以及設(shè)計(jì)者忽視未成年人的保險(xiǎn)需求共同決定的。并且由于兒童醫(yī)療保險(xiǎn)產(chǎn)品具有的區(qū)別于其他產(chǎn)品的特性(醫(yī)療機(jī)構(gòu)的參與和投保人的獨(dú)立性)使其產(chǎn)品風(fēng)險(xiǎn)更為復(fù)雜,增加了產(chǎn)品開發(fā)的難度。最后,市場上提供的產(chǎn)品與少兒醫(yī)保功能的重合也是兒童商業(yè)醫(yī)療保險(xiǎn)產(chǎn)品存在問題的重要表現(xiàn)。 (二)投保人方面。健康險(xiǎn)產(chǎn)品市場意愿強(qiáng)烈、實(shí)際購買不足,并且兒童產(chǎn)品需求在整個(gè)需求中更為滯后,也在一定程度上阻礙了我國商業(yè)兒童醫(yī)療險(xiǎn)的發(fā)展。 (三)醫(yī)療機(jī)構(gòu)方面。對經(jīng)濟(jì)利益的追逐是這方面阻礙兒童商業(yè)醫(yī)療險(xiǎn)發(fā)展的元兇。而保險(xiǎn)三方行為主體間信息不對稱和醫(yī)療機(jī)構(gòu)從業(yè)人員的權(quán)責(zé)不對稱為經(jīng)濟(jì)利益追逐過程中的醫(yī)療費(fèi)用欺詐和過度消費(fèi)行為提供了生長發(fā)育的土壤。(四)政府方面�，F(xiàn)有的兒童醫(yī)療保障相關(guān)規(guī)章中只對社保做出了規(guī)范,而缺乏對商保的規(guī)范限制。而為促進(jìn)商業(yè)健康險(xiǎn)發(fā)展的一系列規(guī)章制度也沒有對兒童領(lǐng)域做出額外的指導(dǎo)管理。所以,從中可以看出兒童商業(yè)醫(yī)療保險(xiǎn)缺乏政策的規(guī)范和支持。 由兒童醫(yī)療保障在社保和商保中的表現(xiàn)可以得出我國發(fā)展商業(yè)兒童醫(yī)療保險(xiǎn)的必要性。 第四部分是我國兒童商業(yè)醫(yī)療保險(xiǎn)的發(fā)展及建議：這部分內(nèi)容先是對我國兒童醫(yī)療保險(xiǎn)保障需求進(jìn)行分析,目的是為了說明發(fā)展的可能性。從我國人民對健康險(xiǎn)購買意愿強(qiáng)烈,我國兒童基數(shù)大、醫(yī)療費(fèi)用支出高,兒童死亡率、發(fā)病率高幾方面得出我國商業(yè)兒童醫(yī)療險(xiǎn)職能的缺失,有很大的發(fā)展空間。 最后又從兒童商業(yè)醫(yī)療保險(xiǎn)得到發(fā)展后的直接受益方(政府、保險(xiǎn)公司以及社會(huì)群眾)的立場出發(fā)為促進(jìn)兒童商業(yè)醫(yī)療險(xiǎn)的發(fā)展給出了建議。 依據(jù)已收集的文獻(xiàn),前人對于此選題并沒有太深入的研究,本文在前人提出的基礎(chǔ)觀點(diǎn)之上,深入分析了影響投保人購買兒童醫(yī)療險(xiǎn)意愿的因素,并對我國兒童商業(yè)醫(yī)療保險(xiǎn)的現(xiàn)狀問題做出較為的精確總結(jié),給出造成此問題的原因。最后從保險(xiǎn)公司、政府行業(yè)組織、社會(huì)群眾角度為我國兒童商業(yè)醫(yī)療保險(xiǎn)的發(fā)展給出建議,其中與兒童醫(yī)療行為有關(guān)的疾病進(jìn)一步細(xì)化、城鄉(xiāng)生活習(xí)性差異等因素對保險(xiǎn)的影響在現(xiàn)有文件較少涉及,希望能夠?yàn)橐院笙嚓P(guān)課題的研究提供一定的幫助。
[Abstract]:There are 367 million (nearly 400 million) children in our country. They are currently in a state of low or no medical security, of which 260 million of children are between 0 and 6 years old. They have no medical insurance and an increase of 12 million per year. The data show that children under 5 years of age in China are dead. The number of people actually reached 400 thousand per year, and the number of deaths caused by the inability to get timely treatment was even up to 240 thousand. In other words, 60% of the children died every year. The number was huge enough to cause us to reflect. China's children's commercial medical insurance is still a commercial medical insurance. It is imperative to develop the medical insurance of our country's commercial children. This will start with the status and problems of China's children's medical insurance, and first analyze the situation of the social medical insurance for children in our country, and join the medical care of our country's commercial children. The reasons for the weakness of the insurance for children's commercial medical insurance are pointed out, and the conclusion of the development of China's children's commercial medical insurance is concluded. Then, the reasons for the difficulties in the development of China's children's commercial medical insurance are discussed. Finally, the demand for the consumer market of the children's commercial medical insurance in China is analyzed and the commercial medical insurance of our country is analyzed. Medical insurance for children from the perspective of government industry organizations, insurance companies and consumers, gives corresponding suggestions for development.
The content of this article is divided into four parts: the first part is the introduction part: it mainly expounds the research background and significance of the topic, and gives a brief reference to the purpose and method of the research.
The second part describes the medical insurance and points out the characteristics of the medical insurance. It defines the insured of children's medical insurance, expounds the special features of the children's medical insurance area, and carries out an in-depth analysis to make the readers master the factors that determine the needs of the children's medical insurance and the characteristics of the children's disease risk. Finally, the developer will clarify the developer. The significance of medical insurance for children.
The third part is the problems and causes of China's children's medical insurance. The purpose of this chapter is to illustrate the necessity of developing children's commercial medical insurance. From the two directions of social insurance and commercial insurance, the problem of the status of China's children's medical insurance is clarified.
First, the popularity of children's social medical insurance is still low, and the popularity of urban children's social medical insurance is lower than that of rural children. In the meantime, the level of medical security provided for children has been low. The conclusion is that our children's basic medical insurance system can not provide services that basically meet the needs of children's medical security.
Then the current situation of China's children's commercial medical insurance is expressed. Although there are a wide range of children's medical insurance products in the commercial insurance market in China, there are few types of insurance, and the existing problems of medium homogeneity and insufficient guarantee are also existing.
The last part of the chapter gives the reasons why children's commercial medical insurance is not well developed in China.
(1) in the insurance company, children's medical insurance has deviated from the market demand at the beginning of the design, which is determined by the particularity of the insurance products and the designer's neglect of the insurance needs of the minors. And because the children's medical insurance products are different from other products (the participation and the insured of the medical institutions) The independence of the products makes the product risk more complex and increases the difficulty of product development. Finally, the reintegration of the products and children's medical insurance function on the market is also an important manifestation of the problems of the children's commercial medical insurance products.
(two) the policy holder. The health insurance product market is strong, the actual purchase is insufficient, and the demand for children's products is lagging behind in the whole demand, and it has also hindered the development of Chinese commercial children's medical insurance to some extent.
(three) the pursuit of economic interests is the main obstacle to the development of children's commercial medical insurance. The asymmetric information between the three parties of the insurance and the asymmetric power and responsibility of the employees of the medical institutions provide the growth and development soil for the medical expense fraud and the excessive consumption behavior in the process of economic interest pursuit. Four) on the government side, the existing regulations on children's medical security are only standardized for social security and lack of standard restrictions on commercial insurance. And a series of rules and regulations to promote the development of commercial health insurance have not made additional guidance to the field of children. Therefore, it can be seen that the lack of policy for children's commercial medical insurance is a rule. Fan and support.
The necessity of developing medical insurance for commercial children can be concluded from the performance of child health care in social security and commercial insurance.
The fourth part is the development and suggestion of China's children's commercial medical insurance: this part is first to analyze the needs of China's children's medical insurance. The purpose is to explain the possibility of development. From the strong willingness of the people to buy health insurance, the basic number of children in our country is large, the cost of medical expenses is high, the mortality rate of children is high and the incidence is high. Several aspects of China's commercial children's medical insurance function missing, there is great room for development.
Finally, from the standpoint of the direct beneficiaries (government, insurance companies and the social masses) after the development of children's commercial medical insurance, some suggestions are given to promote the development of children's commercial medical insurance.
On the basis of the collected literature, the predecessors have not studied this topic too deeply. On the basis of the basic viewpoints of the predecessors, this paper deeply analyzes the factors affecting the willingness of the insured to buy children's medical insurance, and makes a more accurate summary of the problems of the current situation of China's children's commercial medical insurance, and gives the reasons for the problem. Then from the insurance company, the government industry organization, the social point of view for the development of China's children's commercial medical insurance, the development of China's children's commercial medical insurance is given some suggestions, in which the disease related to children's medical behavior is further refined, the difference of living habits and other factors of urban and rural habits on insurance is less involved in the existing documents, hoping to provide a research for future related topics. A definite help.
【學(xué)位授予單位】：西南財(cái)經(jīng)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：F842.684

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本文編號(hào)：1991025