商業(yè)健康保險(xiǎn)與社會(huì)辦醫(yī)協(xié)同發(fā)展的可行性研究
本文選題:醫(yī)療保障 + 醫(yī)改。 參考:《北京交通大學(xué)》2013年碩士論文
【摘要】:當(dāng)前,我國(guó)已經(jīng)建成了世界上規(guī)模最大的醫(yī)保體系,覆蓋了將近13億人口,解決了一個(gè)人口大國(guó)最基本的醫(yī)療保障問(wèn)題,取得了令世界矚目的成就。但我國(guó)目前還處于社會(huì)主義初級(jí)階段,經(jīng)濟(jì)、社會(huì)發(fā)展水平還有限,盡管醫(yī)療衛(wèi)生總費(fèi)用從2005年約8,700億元增長(zhǎng)到至今的約18,000億元,但我們也發(fā)現(xiàn),我國(guó)的人均衛(wèi)生消費(fèi)僅僅約1,300元,位于世界衛(wèi)生組織的193個(gè)成員國(guó)中第114位,屬于中等偏下水平?床‰y、看病貴的問(wèn)題依然是我國(guó)醫(yī)療保障體系需要解決的頭等大事。為此,構(gòu)建多種制度、模式的多層次、多元化醫(yī)療保障體系和醫(yī)療衛(wèi)生服務(wù)體系,已經(jīng)成為我國(guó)本次深化醫(yī)改工作中,解決實(shí)際問(wèn)題的基本共識(shí)。商業(yè)健康保險(xiǎn)在我國(guó)醫(yī)療保障體系中位于第三個(gè)層次,它的發(fā)展目標(biāo)應(yīng)該是遵循市場(chǎng)機(jī)制,解決百姓在基本醫(yī)療保障之外的多元需求。由于當(dāng)前的我國(guó)的政策環(huán)境,以及商業(yè)健康保險(xiǎn)機(jī)構(gòu)自身存在的諸多問(wèn)題,其發(fā)展速度還比較緩慢,難以滿(mǎn)足我國(guó)醫(yī)保體系建設(shè)和廣大百姓對(duì)多元化健康保障的需要。另外,在本次深化醫(yī)改工作中,發(fā)展社會(huì)辦醫(yī),擴(kuò)大醫(yī)療服務(wù)供給,也是解決"看病難、看病貴"問(wèn)題的主要辦法之一。雖然社會(huì)辦醫(yī)近幾年發(fā)展迅速,但在政策相對(duì)滯后,行業(yè)環(huán)境不夠理想,基本醫(yī)保定點(diǎn)資格受限等因素的制約下,以及自身發(fā)展過(guò)程中的一些積累問(wèn)題的影響下,其發(fā)展速度和水平也難以滿(mǎn)足社會(huì)需要。本文在眾多探索商業(yè)健康保險(xiǎn)和社會(huì)辦醫(yī)自身所處環(huán)境、所需政策、所面臨的挑戰(zhàn)和發(fā)展策略等孤立研究之外,拓寬了研究思路,提供了較新的研究視角,并緊密結(jié)合實(shí)際,從實(shí)現(xiàn)商業(yè)健康保險(xiǎn)與社會(huì)辦醫(yī)協(xié)同發(fā)展的目標(biāo)入手,通過(guò)對(duì)大量文獻(xiàn)的深入研究和對(duì)比分析,采用網(wǎng)絡(luò)檢索、研究對(duì)象訪(fǎng)談等方法收集數(shù)據(jù)和現(xiàn)實(shí)依據(jù),結(jié)合有關(guān)經(jīng)濟(jì)學(xué)理論,嘗試找出兩者之間協(xié)同發(fā)展的基礎(chǔ)、協(xié)同發(fā)展模式,并對(duì)協(xié)同發(fā)展過(guò)程中的一些現(xiàn)實(shí)問(wèn)題進(jìn)行分析、研究,提供一定的解決思路。
[Abstract]:At present, China has built the largest medical insurance system in the world, covering nearly 1.3 billion people. It has solved the most basic medical security problem in a populous country, and has made remarkable achievements in the world. However, China is still in the primary stage of socialism, and the level of economic and social development is still limited. Although the total cost of medical and health care has increased from about 870 billion yuan in 2005 to about 1.8 trillion yuan so far, we have also found that China's per capita health consumption is only about 1300 yuan, ranking 114th among the 193 member countries of the World Health Organization. The problem of difficult and expensive medical treatment is still the top priority of our medical security system. Therefore, the construction of a variety of systems, multi-level model, diversified medical security system and medical and health service system has become the basic consensus in the deepening of medical reform in China, to solve practical problems. Commercial health insurance is at the third level in the medical security system of our country. Its development goal should be to follow the market mechanism and solve the multivariate needs of the common people beyond the basic medical security. Because of the current policy environment of our country and many problems existing in the commercial health insurance institutions, the development speed is still slow, which is difficult to meet the needs of the construction of the medical insurance system and the diversified health security of the masses of people in our country. In addition, it is one of the main ways to solve the problem of "difficult to see a doctor and expensive to see a doctor" to develop the social medical service and expand the medical service supply in the course of deepening the medical reform. Although social health care has developed rapidly in recent years, under the constraints of relatively lagging policies, inadequate industry environment, restricted qualification for basic medical insurance, and some accumulated problems in the process of its own development, Its development speed and level also difficult to meet the social needs. In addition to many isolated studies, such as exploring the environment, policies, challenges and development strategies of commercial health insurance and social health care, this paper broadens the research ideas, provides a new research perspective, and closely combines with practice. Starting with the goal of realizing the cooperative development of commercial health insurance and social medical management, through the in-depth study and comparative analysis of a large number of documents, this paper collects data and realistic basis by means of network retrieval, research object interview and so on. Combined with the relevant economic theory, this paper tries to find out the foundation and mode of cooperative development between the two, and analyzes some practical problems in the process of cooperative development, studies them, and provides some ideas for solving them.
【學(xué)位授予單位】:北京交通大學(xué)
【學(xué)位級(jí)別】:碩士
【學(xué)位授予年份】:2013
【分類(lèi)號(hào)】:F842.684;R197.1
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