發(fā)布時(shí)間：2019-03-24 13:25

【摘要】：20世紀(jì)80年代以及90年代早期,我國(guó)社會(huì)醫(yī)療保險(xiǎn)支出急劇增長(zhǎng),建立在基本醫(yī)療保險(xiǎn)基礎(chǔ)上的大病補(bǔ)充醫(yī)療保險(xiǎn)項(xiàng)目賠付控制已經(jīng)成為商業(yè)保險(xiǎn)公司必須面臨的課題。 本文以S區(qū)大病補(bǔ)充醫(yī)療保險(xiǎn)項(xiàng)目賠付控制為研究對(duì)象,首先對(duì)影響國(guó)內(nèi)外醫(yī)療費(fèi)用增加因素：人口老齡化、醫(yī)療保險(xiǎn)制度、國(guó)民收入的增加、醫(yī)療技術(shù)進(jìn)步分別進(jìn)行分析,通過(guò)對(duì)美國(guó)、英國(guó)、德國(guó)、新加坡等國(guó)家開(kāi)展的社會(huì)醫(yī)療保險(xiǎn)項(xiàng)目的啟示,找出了S區(qū)大病補(bǔ)充醫(yī)療保險(xiǎn)項(xiàng)目賠付控制中退休人員占比過(guò)高、賬戶結(jié)余過(guò)低、人均醫(yī)療賠付支出上漲過(guò)快等三大問(wèn)題,提出了s區(qū)大病補(bǔ)充醫(yī)療保險(xiǎn)項(xiàng)目賠付控制對(duì)策,通過(guò)建立市級(jí)統(tǒng)籌、對(duì)定點(diǎn)藥店和醫(yī)療機(jī)構(gòu)的管理、信息系統(tǒng)的建設(shè)、改變支付方式和手段等方式來(lái)保障S區(qū)大病補(bǔ)充醫(yī)療保險(xiǎn)項(xiàng)目的安全運(yùn)行。 本文通過(guò)對(duì)S區(qū)大病補(bǔ)充醫(yī)療保險(xiǎn)項(xiàng)目賠付控制對(duì)策的研究,為商業(yè)保險(xiǎn)公司的大病補(bǔ)充醫(yī)療保險(xiǎn)項(xiàng)目賠付控制提供了可供參考的解決方案。
[Abstract]:In the 1980s and early 1990's, the expenditure of social medical insurance in our country increased rapidly. The compensation control of the major illness supplementary medical insurance project based on the basic medical insurance has become a subject that commercial insurance companies must face. This article takes the S area serious illness supplementary medical insurance item compensation control as the research object, first of all carries on the analysis to the influence domestic and foreign medical treatment expense increase factor: the population aging, the medical insurance system, the national income increase, the medical technology progress respectively, Through the inspiration to the social health insurance programs carried out in the United States, Britain, Germany, Singapore and other countries, it is found that the proportion of retirees and the low balance of accounts are too high and the balance of account is too low in the payment control of the supplemental medical insurance programs in the S region. Three major problems, such as the rapid increase of per capita medical compensation expenditure, have been put forward to control the compensation and payment of supplementary medical insurance items in s district. Through the establishment of municipal co-ordination, the management of designated drugstores and medical institutions, and the construction of information system, have been put forward. Change the way and means of payment to ensure the safe operation of the supplementary medical insurance project in S area. Based on the research on the compensation control strategy of the supplementary medical insurance project in S area, this paper provides a reference solution for the compensation control of the major illness supplementary medical insurance project in the commercial insurance company.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：F842.684

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳新中;俞云燕;;補(bǔ)充醫(yī)療保險(xiǎn)體系建設(shè)及其路徑選擇[J];衛(wèi)生經(jīng)濟(jì)研究;2010年01期

2 朱俊生;;全民健康保障制度:建構(gòu)理念、政府支持的合意水平與成本測(cè)算[J];市場(chǎng)與人口分析;2007年04期

3 王川;;我國(guó)居民主要食物的食用消費(fèi)研究[J];中國(guó)食物與營(yíng)養(yǎng);2006年08期

4 彭奕華,許紅雁,王雁,陳紅,高凌俊;老年人醫(yī)療保險(xiǎn)基金籌集與使用的公平性分析[J];國(guó)際醫(yī)藥衛(wèi)生導(dǎo)報(bào);2005年17期

5 鄧大松,楊紅燕;老齡化趨勢(shì)下基本醫(yī)療保險(xiǎn)籌資費(fèi)率測(cè)算[J];財(cái)經(jīng)研究;2003年12期

6 李劍閣;我國(guó)社會(huì)保障制度改革的幾個(gè)問(wèn)題[J];經(jīng)濟(jì)社會(huì)體制比較;2002年02期

7 張桂普,孫全勝;加入WTO對(duì)中國(guó)醫(yī)藥產(chǎn)業(yè)的影響及應(yīng)采取的對(duì)策[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2002年03期

8 陳文;美國(guó)管理保健的經(jīng)驗(yàn)與啟示[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2001年07期

9 李長(zhǎng)明;中國(guó)農(nóng)村衛(wèi)生發(fā)展現(xiàn)狀與策略思考[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2001年01期

10 應(yīng)曉華,胡善聯(lián),陳文;WTO與我國(guó)商業(yè)醫(yī)療保險(xiǎn)市場(chǎng)[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2000年11期

，

本文編號(hào)：2446363