發(fā)布時(shí)間：2018-03-26 04:01

  本文選題：城鄉(xiāng)基本醫(yī)療保險(xiǎn)　切入點(diǎn)：整合　出處：《山西大學(xué)》2017年碩士論文

【摘要】：近年來,整合城鄉(xiāng)基本醫(yī)療保險(xiǎn)制度已經(jīng)是我國醫(yī)療保險(xiǎn)制度發(fā)展的主要趨勢(shì),因城鄉(xiāng)分割而“碎片化”的醫(yī)療保險(xiǎn)制度問題凸顯:公平性的缺失、重復(fù)性參保、制度難以銜接、統(tǒng)籌層次低等,在中央尚缺頂層設(shè)計(jì)的情況下,從2008年開始一些地方政府都不約而同地自發(fā)地探索醫(yī)療保險(xiǎn)制度的整合,各地政府結(jié)合本地的實(shí)際情況進(jìn)行創(chuàng)造性地整合,不僅將“碎片化”的制度整合起來,而且也提高了醫(yī)保制度的公平性和保障性,隨之也涌現(xiàn)出了各具特色的整合模式,這些各具特色的整合模式不僅為未整合地區(qū)提供了示范和經(jīng)驗(yàn)基礎(chǔ),而且也推動(dòng)了其他地區(qū)進(jìn)行醫(yī)療保險(xiǎn)制度的整合,而2016年國務(wù)院文件《關(guān)于整合城鄉(xiāng)基本醫(yī)療保險(xiǎn)制度的意見》的出臺(tái),更是為未整合地區(qū)提供了強(qiáng)大的政策支撐,將整合工作正式提上了日程。本文通過對(duì)以往整合城鄉(xiāng)基本醫(yī)療保險(xiǎn)的典型實(shí)踐模式進(jìn)行歸納分類:“三合一”大一統(tǒng)模式、“三合二”漸進(jìn)統(tǒng)一模式和“三合二”再商保模式,然后比較其異同,從實(shí)施方案、管理體制、籌集機(jī)制和待遇支付四個(gè)方面對(duì)三大類模式進(jìn)行不同的比較分析,從整合之路、整合之首、整合之力和整合之旨四個(gè)方面總結(jié)了三大類模式的共性特征為整合城鄉(xiāng)基本醫(yī)療保險(xiǎn)制度的有益經(jīng)驗(yàn),再對(duì)各地整合過程中遇到的諸如頂層設(shè)計(jì)不統(tǒng)一、制度碎片難銜接、統(tǒng)籌層次比較低、資源配置不均衡、經(jīng)辦機(jī)構(gòu)能力低和監(jiān)督管理不健全等障礙和問題,針對(duì)性地提出了優(yōu)化整合城鄉(xiāng)基本醫(yī)療保險(xiǎn)制度的對(duì)策建議:完善頂層設(shè)計(jì)、健全銜接機(jī)制、提高統(tǒng)籌層次、均衡城鄉(xiāng)資源、提高經(jīng)辦能力和加強(qiáng)監(jiān)督管理,為今后未整合的地方提供實(shí)踐示范和理論指導(dǎo)。
[Abstract]:In recent years, the integration of urban and rural basic medical insurance system has been the main trend of the development of medical insurance system in China. The system is difficult to link up, the overall planning level is low, and while the central government still lacks a top-level design, some local governments have spontaneously explored the integration of the medical insurance system since 2008. The local governments creatively integrate the local conditions, not only to integrate the fragmented system, but also to improve the fairness and security of the health care system. With this, various integration modes have emerged with their own characteristics. These unique integration models not only provide a model and empirical basis for unintegrated areas, but also promote the integration of medical insurance systems in other regions. And the publication of the 2016 State Council document "opinions on the Integration of Urban and Rural basic Medical Insurance system" provides a strong policy support for unintegrated areas. The integration work has been formally put on the agenda. This paper summarizes and classifies the typical practice models of integrating urban and rural basic medical insurance in the past: "three in one" model, "three in two" progressive unification mode and "three in two" renegotiation mode. Then compare its similarities and differences, from the implementation of the scheme, management system, fund-raising mechanism and treatment payment four aspects of the three major models of different comparative analysis, from the road of integration, integration of the first, The four aspects of integration force and integration aim sum up the common features of the three major models: the beneficial experience of integrating the basic medical insurance system between urban and rural areas, and then the integration process encountered in various places such as the design of the top layer is not uniform, the system fragments are difficult to link up. Some obstacles and problems, such as relatively low overall planning level, unbalanced allocation of resources, low capacity of administrative organizations and imperfect supervision and management, are put forward to optimize and integrate the basic medical insurance system between urban and rural areas: to perfect the top-level design, We should perfect the connection mechanism, improve the overall planning level, balance the urban and rural resources, improve the administrative ability and strengthen the supervision and management, and provide practical demonstration and theoretical guidance for the unintegrated places in the future.
【學(xué)位授予單位】：山西大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1;F842.684

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