【摘要】：隨著時代和經(jīng)濟的發(fā)展,我國城鄉(xiāng)、區(qū)域發(fā)展失衡,城鄉(xiāng)發(fā)展差距不斷加大,社會矛盾尖銳嚴重阻礙了社會穩(wěn)定和經(jīng)濟發(fā)展的速度。人們對醫(yī)療衛(wèi)生服務的需求加大,對醫(yī)保的需求層次變得多樣化,對公平的醫(yī)療服務呼聲變高,落后的醫(yī)保配套措施,難以滿足群眾的需求。建立與經(jīng)濟發(fā)展相適應的城鄉(xiāng)醫(yī)療保險制度也應隨之發(fā)生變化�，F(xiàn)行的醫(yī)療保險制度在運行過程中出現(xiàn)“碎片化”、“多元化”的特征。具體在實踐過程中表現(xiàn)為:城鄉(xiāng)居民待遇差距較大,城鄉(xiāng)居民醫(yī)保出現(xiàn)銜接困難,待遇不公平等問題。隨著工業(yè)化和城市化的推進,戶籍制度被打破,人口流動和結構的變化,需要建立與之配套的醫(yī)療保險制度。本文通過對相關文獻和具體實例進行分析,通過對基本理論的梳理,運用文獻分析法和對比分析法對云南省現(xiàn)行的城鎮(zhèn)職工醫(yī)療保險、城鎮(zhèn)居民醫(yī)療保險、新農(nóng)合政策進行綜合研究,對醫(yī)療保險改革的具體政策進行理論和實踐分析�，F(xiàn)行的醫(yī)療保險制度由于制度設計不合理、籌資手段不足、資金監(jiān)管措施不到位,實施程序不公平,嚴重阻礙了經(jīng)濟的發(fā)展。對醫(yī)療保障機制進行整合和政策銜接是社會發(fā)展的必然要求。云南省位于經(jīng)濟不發(fā)達的西部地區(qū),地區(qū)經(jīng)濟發(fā)展不均衡,本地醫(yī)療保險政策在實施中也遇到了種種困難,對于醫(yī)保統(tǒng)籌銜接機制更是需要進行整體化研究。具體的醫(yī)保政策在實施的過程中需要按照循序漸進的原則進行,因地制宜的出臺具體的政策建議,不能籠統(tǒng)的按照一個模式進行下去。因此,探尋一個適合云南省城鄉(xiāng)醫(yī)保的政策銜接機制就顯得尤為重要了。本文通過對云南省城鄉(xiāng)居民醫(yī)療保險的主要制度實施的模式、運行的基本狀況,存在的問題以及我國城鄉(xiāng)居民醫(yī)�，F(xiàn)狀進行分析。針對醫(yī)療保險統(tǒng)籌銜接機制實施過程中出現(xiàn)的問題進行研究,通過對醫(yī)改實施比較成功的地區(qū),如上海市、安徽省寧國市、重慶市醫(yī)保統(tǒng)籌整合銜接機制建設的成功經(jīng)驗進行典型研究。著力厘清云南省統(tǒng)籌城鄉(xiāng)居民醫(yī)療保險制度,對分散的體制進行整合研究,指出推進制度一體化建設的必要性與可行性。針對整合銜接過程中出現(xiàn)的問題分析原因,通過借鑒各試點地區(qū)取得的成功經(jīng)驗,提出具體的解決措施和意見。并就云南省醫(yī)保統(tǒng)籌銜接機制建設的制度模式和路徑選擇提出相應的對策建議。
[Abstract]:With the development of times and economy, the imbalance of urban and rural development and regional development in China, the increasing gap between urban and rural development, the sharp social contradictions seriously hinder the social stability and the speed of economic development. People's demand for medical and health services has increased, the demand for medical insurance has become diversified, the demand for fair medical services has become higher, and the backward matching measures of medical insurance are difficult to meet the needs of the masses. The establishment of urban and rural medical insurance system in accordance with economic development should also change with it. The current medical insurance system is characterized by fragmentation and diversification. In the process of practice, the difference of treatment between urban and rural residents is large, the medical insurance of urban and rural residents is difficult to link up, the treatment is unfair and so on. With the development of industrialization and urbanization, the household registration system has been broken, and the population flow and structure have changed, so it is necessary to establish a matching medical insurance system. Through the analysis of relevant documents and concrete examples, through combing the basic theory, using the literature analysis method and the comparative analysis method, this paper analyzes the current medical insurance of urban workers and urban residents in Yunnan Province. The new rural cooperative policy carries on the comprehensive research, carries on the theory and the practice analysis to the medical insurance reform concrete policy. The current medical insurance system is seriously hindered by the unreasonable design of the system, insufficient means of financing, inadequate supervision of funds and unfair implementation procedures. The integration of medical security mechanism and policy convergence is the inevitable requirement of social development. Yunnan Province is located in the underdeveloped western region, the regional economic development is not balanced, the local medical insurance policy has also encountered a variety of difficulties in the implementation of the medical insurance system is even more necessary to carry out a holistic study. The specific medical insurance policy in the process of implementation needs to be carried out in accordance with the principle of gradual and orderly, according to local conditions, the introduction of specific policy recommendations, can not be carried out in general according to a model. Therefore, it is particularly important to explore a policy convergence mechanism suitable for urban and rural health insurance in Yunnan Province. This paper analyzes the mode of implementing the main system of medical insurance for urban and rural residents in Yunnan Province, the basic status of operation, the existing problems and the present situation of medical insurance of urban and rural residents in China. Based on the study of the problems in the implementation of the medical insurance linkage mechanism, through the implementation of the more successful areas of medical reform, such as Shanghai, Ningguo City, Anhui Province, The successful experience in the construction of the medical insurance system in Chongqing is studied. This paper makes great efforts to clarify the medical insurance system of urban and rural residents in Yunnan Province, studies the decentralized system, and points out the necessity and feasibility of promoting the construction of institutional integration. This paper analyzes the causes of the problems in the process of integration and cohesion, and puts forward some concrete measures and suggestions through drawing lessons from the successful experiences of each pilot area. And put forward the corresponding countermeasures and suggestions on the institutional model and path selection of the construction of the overall linking mechanism of health insurance in Yunnan Province.
【學位授予單位】：云南財經(jīng)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：F842.684

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