本文選題：基本醫(yī)療保險(xiǎn)　切入點(diǎn)：政府籌資　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景1978年阿拉木圖宣言提出“人人享有基本醫(yī)療服務(wù)”,2005年WHO又提出全民健康覆蓋目標(biāo),確保人人享有基本醫(yī)療服務(wù)�；踞t(yī)療保險(xiǎn)作為一種重要的方式保障居民能夠獲得基本醫(yī)療服務(wù)。中國(guó)從1998年建立城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)開(kāi)始,到2007年城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)(以下簡(jiǎn)稱城居保)試點(diǎn),中國(guó)已基本建立覆蓋不同人群的基本醫(yī)療保險(xiǎn)體系。政府財(cái)政籌資作為基本醫(yī)療保險(xiǎn)主要的籌資方式之一,居民通過(guò)衛(wèi)生服務(wù)利用獲得政府補(bǔ)助。居民基本醫(yī)療保險(xiǎn)政府籌資受益如何?不同基本醫(yī)療保險(xiǎn)人群的受益是否有差異?通過(guò)受益歸屬分析可以清晰解答這些問(wèn)題。研究目標(biāo)在分析不同基本醫(yī)療保險(xiǎn)樣本人群衛(wèi)生服務(wù)利用的基礎(chǔ)上,結(jié)合不同基本醫(yī)療保險(xiǎn)基金的籌資補(bǔ)償情況,分析不同基本醫(yī)療保險(xiǎn)樣本人群政府籌資補(bǔ)助受益分布情況;通過(guò)比較不同基本醫(yī)療保險(xiǎn)政府籌資受益歸屬和公平性,為政府統(tǒng)籌城鄉(xiāng)居民基本醫(yī)療保險(xiǎn)制度的制定、實(shí)施提供證據(jù)支持和政策建議。研究方法采用文獻(xiàn)復(fù)習(xí)法和描述性統(tǒng)計(jì)方法分析樣本省不同基本醫(yī)療保險(xiǎn)籌資補(bǔ)償情況、樣本人群的基本情況和衛(wèi)生服務(wù)利用情況;運(yùn)用受益歸屬分析不同基本醫(yī)療保險(xiǎn)樣本人群政府籌資補(bǔ)助受益分布情況;采用集中指數(shù)和集中曲線等分析樣本人群政府籌資補(bǔ)助受益歸屬公平性。研究結(jié)果1.醫(yī)�；鸹I資補(bǔ)償及衛(wèi)生服務(wù)利用情況新型農(nóng)村合作醫(yī)療保險(xiǎn)(以下簡(jiǎn)稱新農(nóng)合)政府籌資占總籌資的82.66%,城居保政府籌資占總籌資的82.76%,其中住院支出是基本醫(yī)療保險(xiǎn)基金主要支出。新農(nóng)合兩周患病率為19.64%,城居保兩周患病率為23.43%。新農(nóng)合兩周就診率為9.28%,城居保兩周就診率為8.44%,新農(nóng)合樣本人群兩周就診率高于城居保。2.受益歸屬分布情況新農(nóng)合居民門診補(bǔ)助受益最高的為中等收入組,占20.70%,受益最低的為較高收入組,為19.52%。城居保居民門診補(bǔ)助受益最高為中等收入組為24.08%,最高收入組最低為16.36%。新農(nóng)合居民住院補(bǔ)助受益最高的最高收入組為23.73%,較低收入組最低為17.43%。城居保居民住院補(bǔ)助最低收入組最少為15.29%,中等收入組為24.39%。新農(nóng)合居民不同年齡門診受益分布較不均衡,65歲及以上組12.24%的人口獲得26.87%的補(bǔ)助;不同文化程度受益分布呈現(xiàn)文化程度越低,獲得的補(bǔ)助越多的趨勢(shì)。城居保居民門診補(bǔ)助受益分布呈現(xiàn)年齡越大,相對(duì)人口比例來(lái)說(shuō)獲得的補(bǔ)助越多。新農(nóng)合和城居保不同年齡及文化程度居民住院補(bǔ)助受益分布也不均衡,年齡高組和文化程度低組獲得更多的補(bǔ)助。3.受益歸屬公平性新農(nóng)合居民門診補(bǔ)助集中指數(shù)為0.001,住院補(bǔ)助集中指數(shù)為0.025,新農(nóng)合門診補(bǔ)助集中曲線幾乎與公平性重合,新農(nóng)合居民門診補(bǔ)助公平性好于住院補(bǔ)助公平性。城居保居民門診補(bǔ)助集中指數(shù)為0.005,住院補(bǔ)助集中指數(shù)為0.031,高收入者獲得較多補(bǔ)助,政府籌資補(bǔ)助呈現(xiàn)利富性。建議1.提高政府衛(wèi)生財(cái)政投入的針對(duì)性,確保居民受益的公平性;2.加大對(duì)基層醫(yī)療服務(wù)機(jī)構(gòu)投入,保障不同居民獲得均等醫(yī)療衛(wèi)生服務(wù);3.精確計(jì)算醫(yī)療保險(xiǎn)基金支出,合理確定合理報(bào)銷方案;4.科學(xué)嚴(yán)謹(jǐn)制定城鄉(xiāng)統(tǒng)籌基本醫(yī)療制度方案,確保城鄉(xiāng)居民受益公平。
[Abstract]:On the background of the Almaty declaration of 1978 put forward the "universal access to basic medical services, the 2005 WHO proposed universal health coverage to ensure universal access to basic medical services. Basic medical insurance as an important way to protect the residents to obtain basic medical services. China from 1998 to establish the basic medical insurance for urban workers, the urban basic health insurance in 2007 residents (hereinafter referred to as the city home insurance) pilot, China has been basically established the basic medical insurance system covering different groups of people. One of the government finance basic medical insurance as the main mode of financing, the residents through health services to get government subsidies. The basic medical insurance for residents of government financing benefit? Different basic medical insurance groups benefit if there were differences through the analysis of benefit attribution? You can clearly answer these questions. The research target in the analysis The health service utilization based on basic medical insurance population, combined with the financing and compensation of different basic medical insurance fund financing, analysis of distribution of government subsidies for basic medical insurance in different populations; through the comparison of different basic medical insurance government financing benefit attribution and fairness, making for the basic medical insurance system for urban and rural residents and the government. Provide evidence to support the implementation and policy recommendations. The research methods include literature review and descriptive statistical analysis of samples of different funding of basic medical insurance compensation, the population and the basic situation of health service; use benefit attribution analysis of the fund distribution of government subsidies to different basic medical insurance population; the concentration curve and concentration index etc. Analysis of the sample population for government funding subsidies benefit fairness. Results 1 The health insurance fund. Compensation and health service of the new rural cooperative medical insurance (NCMS) government financing accounted for the total funding of 82.66%, the city ranks of government financing total financing 82.76%, the hospitalization expenditure is the basic medical insurance fund expenditure. The new IICA two week prevalence rate is 19.64%, the city ranks two the prevalence rate of 23.43%. new two week visiting rate was 9.28%, the city ranks two week visiting rate was 8.44%, two weeks treatment rate of NCMS population than the city ranks the sample.2. benefit distribution of NCMS outpatient subsidies for the highest middle-income group, accounting for 20.70%, the lowest for the benefit of higher income groups, 19.52%. City home insurance outpatient subsidies for the highest middle-income group was 24.08%, the highest income group is the lowest for 16.36%. residents NCMS hospitalization subsidy benefit highest of the highest income group is 23.73%, the lower income group A minimum of 17.43%. city ranks the residents of hospitalization for at least 15.29% of the lowest income group, middle income residents in different age group for the 24.39%. medical outpatient benefit distribution is not balanced, 65 years or more. 12.24% of the population get 26.87% subsidy; different cultural benefit distribution in the lower level of education, more subsidies obtained by city trend. Home insurance outpatient subsidy benefit distribution showed the older, more subsidies relative terms of the proportion of the population obtained. NCMS and the city ranks of different age and culture degree of residents hospitalization subsidy benefit distribution is not balanced, the high age group and low education group to get more subsidies.3. benefit fairness NCMS outpatient subsidy concentration index 0.001, hospitalization subsidy concentration index is 0.025, outpatient subsidies and equity concentration curves almost coincide, NCMS residents outpatient subsidy fairness To grant equity in hospital. The city ranks the outpatient subsidy concentration index was 0.005, hospitalization subsidy concentration index is 0.031, high earners get more subsidies, government funding subsidies appear rich. 1. suggestions to improve the government health investment, to ensure the fairness of residents from 2.; increase investment in primary health care different security services, residents equal access to health services; 3. the accurate calculation of the expenditure of health insurance fund, reasonable reimbursement scheme; 4. scientific develop urban and rural basic medical system, urban and rural residents to ensure fair benefit.

【學(xué)位授予單位】：寧夏醫(yī)科大學(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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