【摘要】：隨著社會(huì)進(jìn)步經(jīng)濟(jì)發(fā)展,我國(guó)醫(yī)療衛(wèi)生行業(yè)發(fā)展穩(wěn)定,我國(guó)公眾基本醫(yī)療保險(xiǎn)制度基本落實(shí)。基本醫(yī)療保險(xiǎn)作為社會(huì)保障體系的重要組成部分,是消除城鄉(xiāng)居民“看病難,看病貴”問(wèn)題的根本而有效的制度安排。城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)與新型農(nóng)村合作醫(yī)療兩種制度互為補(bǔ)充,基本覆蓋了我國(guó)絕大部分的城鎮(zhèn)和農(nóng)村居民,但由于城鄉(xiāng)差異的存在,產(chǎn)業(yè)結(jié)構(gòu)的調(diào)整,城市化進(jìn)程的加速,造成兩種制度獨(dú)立運(yùn)行,無(wú)法互通有無(wú),同時(shí)也很難轉(zhuǎn)移和進(jìn)行有效承接,造成了現(xiàn)有資源的浪費(fèi)和不合理運(yùn)用。因此,為了實(shí)現(xiàn)“全民醫(yī)保”,我國(guó)在部分地區(qū)先后進(jìn)行了城居醫(yī)保和新農(nóng)合制度銜接和整合的有益嘗試,積累了一定的寶貴實(shí)踐經(jīng)驗(yàn)。本文以逆向選擇理論、公平理論、統(tǒng)籌城鄉(xiāng)理論、公平理論、公共物品理論等公共管理學(xué)相關(guān)理論為理論基礎(chǔ),對(duì)國(guó)內(nèi)外基本醫(yī)療保險(xiǎn)制度研究情況加以總結(jié),為本文課題研究提供參考。以遼寧省營(yíng)口市為例,對(duì)城鎮(zhèn)居民醫(yī)療保險(xiǎn)與新型農(nóng)村合作醫(yī)療并軌問(wèn)題加以研究。通過(guò)對(duì)區(qū)域內(nèi)城鎮(zhèn)居民醫(yī)療保險(xiǎn)與新型農(nóng)村合作獨(dú)立運(yùn)行存在的問(wèn)題及問(wèn)題成因,對(duì)兩種基本醫(yī)療保險(xiǎn)制度并軌進(jìn)行可行性分析,借鑒國(guó)內(nèi)外的相關(guān)成功經(jīng)驗(yàn),探索解決問(wèn)題的對(duì)策建議。通過(guò)對(duì)遼寧省營(yíng)口市的城鎮(zhèn)居民醫(yī)療保險(xiǎn)和新型農(nóng)村合作醫(yī)療的政策和現(xiàn)狀對(duì)比,兩種制度在參保對(duì)象覆蓋人群、籌資方式及標(biāo)準(zhǔn)、報(bào)銷(xiāo)支付方式及醫(yī)保待遇等幾個(gè)方面存在差異。而兩種基本醫(yī)療保險(xiǎn)制度的獨(dú)立運(yùn)行產(chǎn)生又產(chǎn)生了以下問(wèn)題,即城鄉(xiāng)二元分割的醫(yī)保制度缺乏公平、個(gè)人繳費(fèi)的組織成本高、多頭管理浪費(fèi)資源、政府監(jiān)管不力、自愿參與的“逆向選擇”與“道德風(fēng)險(xiǎn)”隱患、統(tǒng)籌層次低導(dǎo)致抗風(fēng)險(xiǎn)性差等。通過(guò)對(duì)營(yíng)口市醫(yī)療保險(xiǎn)制度的相關(guān)討論,又將發(fā)達(dá)國(guó)家的先進(jìn)經(jīng)驗(yàn)進(jìn)行總結(jié),本文闡述了營(yíng)口市城鄉(xiāng)居民醫(yī)療保險(xiǎn)制度并軌的對(duì)策建議,即加大政府投入、實(shí)現(xiàn)城鄉(xiāng)居民戶(hù)籍制度一元化、建立“一制多檔”的繳費(fèi)標(biāo)準(zhǔn)和待遇標(biāo)準(zhǔn)、統(tǒng)籌管理體制、加強(qiáng)對(duì)醫(yī)療機(jī)構(gòu)的監(jiān)督、確定長(zhǎng)期的參保關(guān)系等。通過(guò)以上論述,對(duì)現(xiàn)階段營(yíng)口市城鄉(xiāng)居民醫(yī)療保險(xiǎn)制度并軌的可行性進(jìn)行了探討,從而能夠在一定程度上為進(jìn)一步探索構(gòu)架符合我市實(shí)際的城鄉(xiāng)居民醫(yī)療保險(xiǎn)體制和機(jī)制,完善相關(guān)政策及制度設(shè)計(jì)提供參考和借鑒。
[Abstract]:With the development of society and economy, the development of medical and health industry in China is stable, and the basic medical insurance system of our country is basically implemented. As an important part of the social security system, the basic medical insurance is the fundamental and effective institutional arrangement to eliminate the problem of "difficult to see a doctor, expensive to see a doctor" for urban and rural residents. The basic medical insurance of urban residents and the new rural cooperative medical system complement each other and cover the vast majority of urban and rural residents in China. However, due to the existence of differences between urban and rural areas, the adjustment of industrial structure, the acceleration of urbanization. As a result, the two systems operate independently and can not be used for each other. At the same time, it is very difficult to transfer and undertake effectively, which results in the waste and unreasonable utilization of existing resources. Therefore, in order to realize the "universal medical insurance", China has carried out a beneficial attempt to link up and integrate the urban health insurance system and the new rural cooperative system in some areas, and accumulated some valuable practical experience. Based on reverse selection theory, equity theory, urban-rural theory, equity theory, public goods theory and other related theories of public management, this paper summarizes the research situation of basic medical insurance system at home and abroad. It provides a reference for the research of this paper. Taking Yingkou City, Liaoning Province as an example, this paper studies the integration of urban residents' medical insurance and new rural cooperative medical system. This paper analyzes the feasibility of the two basic medical insurance systems by analyzing the problems and the causes of the problems existing in the independent operation of the regional urban residents' medical insurance and the new type of rural cooperation, and draws lessons from the relevant successful experience at home and abroad. Explore the countermeasures and suggestions to solve the problem. By comparing the policies and current situation of urban residents' medical insurance and new rural cooperative medical insurance in Yingkou City, Liaoning Province, the two systems cover the population, financing methods and standards. Reimbursement payment method and medical insurance treatment and so on several aspects exist the difference. However, the independent operation of the two basic medical insurance systems has produced the following problems: the lack of fairness in the dual urban-rural medical insurance system, the high organization cost of individual contributions, the waste of resources by multiple management, and the weak supervision of the government. Voluntary participation of "adverse selection" and "moral hazard" hidden dangers, low co-ordination level lead to poor risk resistance and so on. By discussing the medical insurance system of Yingkou City and summarizing the advanced experience of the developed countries, this paper expounds the countermeasures and suggestions for the integration of the medical insurance system of the urban and rural residents of Yingkou City, that is, to increase government investment. To realize the unification of the household registration system of urban and rural residents, to establish the standard of payment and treatment of "one system and multi-file", to coordinate the management system, to strengthen the supervision of medical institutions, and to determine the long-term relationship between participation and insurance, etc. Through the above discussion, this paper probes into the feasibility of merging the urban and rural residents' medical insurance system in Yingkou at this stage, so as to further explore the system and mechanism of medical insurance for urban and rural residents in accordance with the actual situation in our city to a certain extent. Improve the relevant policies and system design to provide reference and reference.
【學(xué)位授予單位】：大連海事大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：F842.684;R197.1

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