發(fā)布時(shí)間：2018-04-13 08:52

  本文選題：大病醫(yī)保 + “疾病劃分”模式�。� 參考：《華東師范大學(xué)》2013年碩士論文

【摘要】：我國(guó)目前主要通過(guò)實(shí)施城鎮(zhèn)職工補(bǔ)充醫(yī)療保險(xiǎn)制度、城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)制度、新型農(nóng)村合作醫(yī)療制度以及大病醫(yī)療救助制度實(shí)行對(duì)大病醫(yī)療的保障。然而大病的補(bǔ)償率仍然較低,重特大疾病的高額醫(yī)療費(fèi)用給廣大群眾尤其是農(nóng)村居民的生產(chǎn)生活帶來(lái)嚴(yán)重的負(fù)擔(dān)。 為進(jìn)一步完善城鄉(xiāng)居民的醫(yī)療保險(xiǎn)制度,大病醫(yī)保應(yīng)運(yùn)而生。大病醫(yī)保是對(duì)城鎮(zhèn)居民以及新農(nóng)合參保人補(bǔ)償后個(gè)人費(fèi)用的二次補(bǔ)償,根據(jù)保險(xiǎn)責(zé)任上的差異可分為“疾病劃分”模式和“費(fèi)用”模式兩種。本文主要對(duì)“疾病劃分”模式下的大病醫(yī)保進(jìn)行研究,為大病醫(yī)保中疾病的選取、實(shí)際發(fā)病率的計(jì)算以及凈保費(fèi)的預(yù)測(cè)提供定量測(cè)量方法與理論思路。 本文首先闡述大病醫(yī)保在我國(guó)的發(fā)展,并根據(jù)國(guó)外大病保障制度提出對(duì)我國(guó)大病醫(yī)保的啟示。接著介紹了多層線性模型及其在大病醫(yī)保研究中的適用性。最后以“大病”定義出發(fā)進(jìn)行實(shí)證研究依據(jù)自付金額高低選取了7種疾病并進(jìn)行權(quán)重賦值。根據(jù)所選取的疾病建立二層線性模型,分析影響自付金額的因素以及疾病種類(lèi)對(duì)關(guān)鍵因素的解釋作用,并預(yù)測(cè)不同性別、年齡層的居民的人均自付金額,再結(jié)合7種疾病的實(shí)際發(fā)病率,大致測(cè)算了疾病模式大病保險(xiǎn)的風(fēng)險(xiǎn)保費(fèi)。 研究表明：住院時(shí)間以及醫(yī)院級(jí)別都對(duì)自付金額有比較大的正向影響作用;但是在不同的城市,疾病對(duì)自付費(fèi)用影響因素的解釋作用卻不一樣。疾病數(shù)量以及疾病種類(lèi)的不同,地區(qū)人群的差異、補(bǔ)償比例的差異,合理必須常規(guī)醫(yī)療費(fèi)用的限制或者突破、微利的邊界、以及歷史經(jīng)驗(yàn)數(shù)據(jù)都會(huì)對(duì)大病保險(xiǎn)的費(fèi)率厘定產(chǎn)生影響。因此商業(yè)保險(xiǎn)機(jī)構(gòu)承�！凹膊∧Ｊ健贝蟛♂t(yī)保時(shí)必須因地制宜的做出相應(yīng)的調(diào)整,合理控制承保風(fēng)險(xiǎn)。
[Abstract]:At present, the system of supplementary medical insurance for urban staff and workers, the basic medical insurance system for urban residents, the new rural cooperative medical system and the medical aid system for serious illness are mainly implemented in China.However, the compensation rate of the serious illness is still low, and the high medical expenses of the serious and serious diseases bring a serious burden to the masses, especially the rural residents.In order to further improve the medical insurance system for urban and rural residents, health insurance emerged as the times require.Medical insurance for serious illness is a kind of secondary compensation for personal expenses after compensation to urban residents and the new rural cooperative insured. According to the difference in insurance liability, it can be divided into two types: "disease division" model and "expense" mode.This paper mainly studies the medical insurance of serious illness under the model of "disease division", which provides a quantitative measurement method and theoretical thinking for the selection of disease, the calculation of actual incidence rate and the prediction of net insurance premium.This paper first expounds the development of medical insurance for serious illness in our country, and puts forward the enlightenment to the medical insurance of serious illness in our country according to the safeguard system of serious illness abroad.Then it introduces the multilayer linear model and its applicability in the study of medical insurance for serious illness.Finally, based on the definition of "serious illness", seven diseases are selected and weighted.Based on the selected disease, a two-layer linear model was established to analyze the factors affecting the out-of-pocket amount and the explanation of the disease type to the key factors, and to predict the per-capita out-of-pocket amount of the residents of different gender and age groups.Combined with the actual incidence of 7 diseases, the risk insurance premium of the disease model is estimated.The results show that the length of stay and the level of hospital have a great positive effect on the out-of-pocket amount, but in different cities, the effect of disease on the factors of out-of-pocket expenses is not the same.The difference in the number of diseases and the types of diseases, the differences in regional population, the difference in compensation ratio, the reasonable need for the limitation or breakthrough of conventional medical expenses, and the marginal profit boundary,And historical data will have an impact on the pricing of major illness insurance.Therefore, the commercial insurance institutions must make corresponding adjustments according to local conditions and control the underwriting risk reasonably.
【學(xué)位授予單位】：華東師范大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：F842.684;F224

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 蔡文俊,李一平,丁義民,鄭偉一,王祥云,陳愛(ài)武,王建宏;總量控制與個(gè)人付費(fèi)相結(jié)合的費(fèi)用控制機(jī)制的探索[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2000年04期

2 方豪,趙郁馨,王建生,萬(wàn)泉,杜樂(lè)勛;衛(wèi)生籌資公平性研究——家庭災(zāi)難性衛(wèi)生支出分析[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2003年06期

3 左樹(shù)巖,鞠秀榮;探索合作醫(yī)療制度下的大病補(bǔ)償比[J];衛(wèi)生經(jīng)濟(jì)研究;2001年03期

4 楊衛(wèi)華;城鎮(zhèn)醫(yī)保改革的倫理意義及其問(wèn)題[J];中國(guó)醫(yī)學(xué)倫理學(xué);2005年03期

5 俞衛(wèi);楊永梅;;中國(guó)農(nóng)民大病醫(yī)療負(fù)擔(dān)研究:基于印度的經(jīng)驗(yàn)[J];學(xué)習(xí)與探索;2012年02期

6 黃結(jié)平;劉海霞;;我國(guó)重大疾病險(xiǎn)存在問(wèn)題與發(fā)展對(duì)策[J];保險(xiǎn)職業(yè)學(xué)院學(xué)報(bào);2006年05期

7 朱玉;曹袁媛;胡運(yùn)濤;王靜;;預(yù)測(cè)疾病發(fā)病率的統(tǒng)計(jì)分析方法進(jìn)展[J];中國(guó)衛(wèi)生統(tǒng)計(jì);2010年01期

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