本文選題：大病保險(xiǎn) + 籌資��； 參考：《中國(guó)礦業(yè)大學(xué)》2017年碩士論文

【摘要】：城鄉(xiāng)居民大病保險(xiǎn)作為基本醫(yī)療保險(xiǎn)的延伸和拓展,是為了防止城鄉(xiāng)居民因病致貧、因病返貧而實(shí)施的。在PPP理論、福利多元主義理論和公共產(chǎn)品理論的指導(dǎo)下,大病保險(xiǎn)在實(shí)施過(guò)程中開(kāi)展公私合作,引入了市場(chǎng)競(jìng)爭(zhēng)機(jī)制,采取由商業(yè)保險(xiǎn)機(jī)構(gòu)承辦的方式,目的是為提高其經(jīng)辦效率和質(zhì)量。自2012年國(guó)家發(fā)改委等六部委發(fā)布了關(guān)于實(shí)施城鄉(xiāng)居民大病保險(xiǎn)的意見(jiàn)后,大病保險(xiǎn)的全國(guó)試點(diǎn)、推廣工作就此鋪開(kāi),后中央政府和各地政府亦出臺(tái)了相關(guān)措施促使其進(jìn)一步推廣和實(shí)施。大病保險(xiǎn)的實(shí)施各地因地制宜,取得不錯(cuò)成就,雖沒(méi)有可以照搬的模式,但仍可以相互借鑒和促進(jìn)。通過(guò)對(duì)徐州市大病保險(xiǎn)運(yùn)行現(xiàn)狀的調(diào)查研究,發(fā)現(xiàn)徐州市大病保險(xiǎn)運(yùn)行機(jī)制中存在籌資渠道單一,統(tǒng)籌層次偏低;城鄉(xiāng)待遇不同,賠付水平偏低;招投標(biāo)不透明,存在虧損運(yùn)營(yíng);公私合作有限,商保參與度不足;信息公開(kāi)不足,社會(huì)監(jiān)督缺位。分析得出主要是緣于大病保險(xiǎn)過(guò)度依賴基本醫(yī)療保險(xiǎn),其制度基礎(chǔ)和社會(huì)經(jīng)濟(jì)發(fā)展水平不同,商業(yè)保險(xiǎn)機(jī)構(gòu)缺乏大病保險(xiǎn)運(yùn)行經(jīng)驗(yàn),服務(wù)意識(shí)不強(qiáng),政策宣傳不到位。對(duì)此,提出精算籌資水平,拓寬籌資渠道;加強(qiáng)各方合作,增強(qiáng)服務(wù)意識(shí);建立健全專業(yè)化的運(yùn)營(yíng)管理平臺(tái)、承保管理體系、醫(yī)療風(fēng)險(xiǎn)控制機(jī)制和客戶服務(wù)體系;完善信息公開(kāi)與多方參與的監(jiān)管制度。
[Abstract]:As an extension and expansion of basic medical insurance, urban and rural residents' serious illness insurance is to prevent urban and rural residents from becoming poor because of illness and returning to poverty because of illness. Under the guidance of PPP theory, welfare pluralism theory and public product theory, the major illness insurance carried out public-private cooperation in the implementation process, introduced the market competition mechanism, and adopted the way of undertaking by commercial insurance institutions. The aim is to improve the efficiency and quality of operation. Since the National Development and Reform Commission and other six ministries and commissions issued their opinions on the implementation of serious illness insurance for urban and rural residents in 2012, the national pilot project of the serious illness insurance has spread out. After the central government and local governments also issued measures to promote its further promotion and implementation. The implementation of serious illness insurance can be adapted to local conditions and has made good achievements, although there is no model to copy, but still can learn from each other and promote. Through the investigation and research on the operation status of serious illness insurance in Xuzhou, it is found that there are single financing channels, low overall planning level, different treatment between urban and rural areas, low compensation level, opaque bidding and bidding in Xuzhou serious illness insurance operation mechanism. There are loss-making operation, limited public-private cooperation, insufficient participation in business insurance, insufficient information disclosure and lack of social supervision. The main reason is that the insurance of serious illness depends on the basic medical insurance, its system foundation and the level of social and economic development are different, the commercial insurance institutions lack the operation experience of the insurance of serious illness, the service consciousness is not strong, and the policy propaganda is not in place. In view of this, the author puts forward the level of actuarial financing, widening the financing channel, strengthening the cooperation of all parties, strengthening the service consciousness, establishing and perfecting the specialized operation management platform, underwriting management system, medical risk control mechanism and customer service system. Improve the information disclosure and multi-participation regulatory system.
【學(xué)位授予單位】：中國(guó)礦業(yè)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：F842.684

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 方黎明;;大病保險(xiǎn)發(fā)展的制約因素[J];金融博覽;2016年12期

2 劉洋;;城鄉(xiāng)居民大病保險(xiǎn)問(wèn)題與對(duì)策研究——以陜西省為例[J];西安交通大學(xué)學(xué)報(bào)(社會(huì)科學(xué)版);2016年06期

3 高傳勝;;包容性發(fā)展視角下城鄉(xiāng)居民大病保險(xiǎn)新政再思考[J];社會(huì)科學(xué)戰(zhàn)線;2016年03期

4 周正祥;張秀芳;張平;;新常態(tài)下PPP模式應(yīng)用存在的問(wèn)題及對(duì)策[J];中國(guó)軟科學(xué);2015年09期

5 鄧微;盧婷;;我國(guó)城鄉(xiāng)居民大病保險(xiǎn)籌資機(jī)制探討——基于全國(guó)28個(gè)省市的樣本分析[J];中國(guó)醫(yī)療保險(xiǎn);2015年08期

6 劉曉凱;張明;;全球視角下的PPP:內(nèi)涵、模式、實(shí)踐與問(wèn)題[J];國(guó)際經(jīng)濟(jì)評(píng)論;2015年04期

7 石楓;;城鄉(xiāng)居民大病保險(xiǎn)運(yùn)行困境及問(wèn)題[J];現(xiàn)代經(jīng)濟(jì)信息;2015年12期

8 盧婷;;大病醫(yī)療保險(xiǎn)“湖南模式”的實(shí)踐及展望[J];湖南行政學(xué)院學(xué)報(bào);2015年02期

9 李祝用;喬石;CFP;;從“先行試點(diǎn)”到“全面開(kāi)展”——從政策變遷解析“新國(guó)十條”對(duì)大病保險(xiǎn)的推動(dòng)作用[J];中國(guó)保險(xiǎn);2014年10期

10 鐘偉家;陶四海;;城鄉(xiāng)居民大病保險(xiǎn)籌資機(jī)制探討[J];管理觀察;2014年25期

相關(guān)重要報(bào)紙文章 前2條

1 王寶敏;沈健蓉;畢勝;趙亞男;;大病保險(xiǎn)制度可持續(xù)發(fā)展的路徑選擇[N];中國(guó)保險(xiǎn)報(bào);2014年

2 陳文輝;;構(gòu)建可持續(xù)城鄉(xiāng)居民大病保險(xiǎn)發(fā)展模式[N];經(jīng)濟(jì)日?qǐng)?bào);2013年

，

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