本文選題：城鄉(xiāng)醫(yī)療保險(xiǎn)　切入點(diǎn)：個(gè)人醫(yī)療費(fèi)用負(fù)擔(dān)模型　出處：《遼寧大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：我國一直致力于構(gòu)建能夠覆蓋全民的社會(huì)醫(yī)療保障體系，在十多年的發(fā)展過程中，已經(jīng)初步建立了具有中國特色的社會(huì)醫(yī)療保障體系。這個(gè)體系以社會(huì)基本醫(yī)療保險(xiǎn)為核心，由多層次的醫(yī)療保障構(gòu)成。城鎮(zhèn)居民的社會(huì)基本醫(yī)療保險(xiǎn)由城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)和城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)制度共同組成。農(nóng)村居民的社會(huì)基本醫(yī)療保險(xiǎn)由新型農(nóng)村合作醫(yī)療保險(xiǎn)制度進(jìn)行保障。但是在實(shí)現(xiàn)全民醫(yī)保的發(fā)展目標(biāo)面前，雖然在政策上各地己經(jīng)實(shí)現(xiàn)了全面覆蓋，但是其實(shí)現(xiàn)的水平并不理想，城鄉(xiāng)間在籌資水平與報(bào)銷比例上存在較大差距。 目前我國已經(jīng)構(gòu)建起世界上規(guī)模最大的醫(yī)療保障網(wǎng)，依據(jù)當(dāng)前國家關(guān)于建立“全民醫(yī)�！钡臉�(gòu)想，全體居民個(gè)人的醫(yī)療負(fù)擔(dān)本應(yīng)是一致的，但由于醫(yī)療保險(xiǎn)多軌制使得醫(yī)療資源分配不公，城鄉(xiāng)居民由于參加不同的醫(yī)療保險(xiǎn)制度，籌資水平與報(bào)銷政策存在較大差異，導(dǎo)致居民個(gè)人的醫(yī)療費(fèi)用負(fù)擔(dān)水平存在較大差距。 本文首先介紹了相關(guān)概念及基礎(chǔ)理論。著重對研究中需要使用的重要概念進(jìn)行了內(nèi)涵和外延的界定，，同時(shí)對生存公平與勞動(dòng)公平理論、羅爾斯的正義論、公共物品理論等相關(guān)基礎(chǔ)理論進(jìn)行論述。然后闡述了遼寧省城鄉(xiāng)醫(yī)療保險(xiǎn)發(fā)展歷程及籌資與給付的制度現(xiàn)狀。概括了城鄉(xiāng)醫(yī)療保險(xiǎn)制度實(shí)施以來的籌資水平變動(dòng)和調(diào)整的情況，以及門診和住院的報(bào)銷比例情況。采用兩個(gè)指標(biāo)分析城鄉(xiāng)醫(yī)療保險(xiǎn)個(gè)人負(fù)擔(dān)水平的差距，建立了衡量醫(yī)療保險(xiǎn)個(gè)人負(fù)擔(dān)水平差距的模型，并通過采用模型假設(shè)以及大量的實(shí)證研究，分析城鄉(xiāng)醫(yī)療保險(xiǎn)個(gè)人醫(yī)療費(fèi)用負(fù)擔(dān)水平的差距。并分別分析了門診醫(yī)療費(fèi)用個(gè)人負(fù)擔(dān)水平與住院醫(yī)療費(fèi)用的個(gè)人負(fù)擔(dān)水平。鑒于此分析造成城鄉(xiāng)醫(yī)療保險(xiǎn)個(gè)人負(fù)擔(dān)水平差距的成因及后果。首先從造成醫(yī)療保險(xiǎn)個(gè)人負(fù)擔(dān)的政策原因、內(nèi)在原因與外在原因進(jìn)行考量，其次分析城鄉(xiāng)醫(yī)療保險(xiǎn)個(gè)人負(fù)擔(dān)差距過大導(dǎo)致因病致貧、因病返貧，城鄉(xiāng)經(jīng)濟(jì)差距加大的后果。最后基于城鄉(xiāng)統(tǒng)籌一體化和“全民醫(yī)�！钡囊暯翘岢隽丝s小遼寧省城鄉(xiāng)醫(yī)療保險(xiǎn)個(gè)人負(fù)擔(dān)水平差距、促進(jìn)社會(huì)公平的政策建議。如提高統(tǒng)籌層次完善醫(yī)療保障水平、增加財(cái)政補(bǔ)貼促進(jìn)城鄉(xiāng)醫(yī)療保險(xiǎn)公平、加強(qiáng)資金管理完善繳費(fèi)機(jī)制、整合醫(yī)療資源實(shí)現(xiàn)醫(yī)療保障事業(yè)公平發(fā)展。
[Abstract]:Our country has been working hard to build a social medical security system that can cover all the people. In the course of more than 10 years of development, we have initially established a social medical security system with Chinese characteristics. The core of this system is social basic medical insurance. The social basic medical insurance of urban residents is composed of the basic medical insurance of urban workers and the basic medical insurance system of urban residents. The social basic medical insurance of rural residents is a new type. Rural cooperative medical insurance system is guaranteed. But in front of realizing the development goal of universal medical insurance, Although the overall coverage has been realized in all parts of the policy, the level of its realization is not ideal, and there is a big gap between the level of financing and the proportion of reimbursement between urban and rural areas. At present, China has built the largest medical insurance network in the world. According to the current concept of establishing "universal health insurance," the medical burden of all residents should be the same. However, the multi-track system of medical insurance makes the distribution of medical resources unfair, and the level of financing and reimbursement policy of urban and rural residents are quite different because of their participation in different medical insurance systems, which leads to a large gap in the level of individual medical expenses burden of residents. This paper first introduces the related concepts and basic theories. It focuses on the definition and extension of the important concepts that need to be used in the research. At the same time, it defines the theory of survival fairness and labor equity, Rawls' theory of justice. Then it expounds the development course of urban and rural medical insurance in Liaoning Province and the current situation of financing and payment system. It summarizes the changes and adjustments of the level of financing since the implementation of the medical insurance system in urban and rural areas. And the proportion of outpatient and inpatient reimbursement. Two indexes are used to analyze the gap between urban and rural medical insurance individual burden level, and a model to measure the difference of medical insurance individual burden level is established. And through the use of model assumptions and a large number of empirical research, This paper analyzes the difference between the level of individual medical expense burden in urban and rural medical insurance, and analyzes the level of individual burden of outpatient medical expenses and hospitalization medical expenses respectively. In view of this analysis, the individual medical insurance in urban and rural areas is caused by this analysis. The causes and consequences of the gap in burden level. First of all, from the policy reasons of the personal burden of medical insurance, The internal and external reasons are considered. Secondly, it is analyzed that the gap between the individual burden of urban and rural medical insurance is too large to lead to poverty due to illness, and to return to poverty because of illness. Finally, based on the integration of urban and rural areas and the perspective of "universal health insurance", the author proposes to narrow the gap in the level of individual burden of urban and rural medical insurance in Liaoning Province. Policy suggestions for promoting social equity, such as improving the overall level and improving the level of medical security, increasing financial subsidies to promote the equity of urban and rural medical insurance, strengthening the management of funds and perfecting the payment mechanism, integrating medical resources to achieve the equitable development of medical security.
【學(xué)位授予單位】：遼寧大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：F842.684

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