本文選題：京津滬 + 醫(yī)療保險(xiǎn)��； 參考：《北京交通大學(xué)》2014年碩士論文

【摘要】：上世紀(jì)九十年代末,我國(guó)開始進(jìn)行城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)制度改革；2003年開始,我國(guó)開始在農(nóng)村地區(qū)開展新型農(nóng)村合作醫(yī)療制度；2007年開始開展城鎮(zhèn)居民(非從業(yè)人員)基本醫(yī)療保險(xiǎn)制度的試點(diǎn),目前我國(guó)已初步形成了城鄉(xiāng)居民全部納入醫(yī)療保險(xiǎn)網(wǎng)絡(luò)結(jié)構(gòu)的格局。但是,由于地區(qū)經(jīng)濟(jì)發(fā)展的不平衡等原因,同時(shí)出現(xiàn)了城鄉(xiāng)居民醫(yī)療保障待遇差距較大、不同地區(qū)居民之間醫(yī)療保障待遇懸殊等問題。甚至,即便是同一地區(qū),不同就業(yè)形式的居民群體醫(yī)療保障待遇也不盡相同。如何在基于我國(guó)國(guó)情的基礎(chǔ)上,發(fā)現(xiàn)我國(guó)基本醫(yī)療保險(xiǎn)存在的主要問題,找出造成相關(guān)問題的根本原因,進(jìn)而建立一個(gè)兼顧公平和效率的醫(yī)療保險(xiǎn)制度,成為我國(guó)醫(yī)療保險(xiǎn)制度當(dāng)前面臨的重要課題。 本文主要采用文獻(xiàn)分析法、內(nèi)容分析法和比較分析法等方法,以京津滬三地為樣本地區(qū),第一,系統(tǒng)梳理和比較了京津滬三地醫(yī)療保險(xiǎn)模式及發(fā)展上的差異。分析發(fā)現(xiàn)京津滬三地由于經(jīng)濟(jì)發(fā)展情況及其他因素影響,在醫(yī)療保險(xiǎn)的實(shí)施模式及發(fā)展方向上略有差異。北京側(cè)重于對(duì)醫(yī)療保險(xiǎn)體系的構(gòu)建,天津側(cè)重于城鄉(xiāng)醫(yī)療保險(xiǎn)的統(tǒng)籌以及管理部門的統(tǒng)一,上海著力于發(fā)展全城醫(yī)療保險(xiǎn)統(tǒng)籌(不分戶籍,不分籍貫)。第二,分別從覆蓋人群、參�，F(xiàn)狀、籌資機(jī)制與水平、保障待遇四個(gè)方面為維度對(duì)京津滬三地醫(yī)療保險(xiǎn)進(jìn)行了比較分析,對(duì)城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)、城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)和新型農(nóng)村合作醫(yī)療制度三種醫(yī)保制度進(jìn)行了系統(tǒng)的比較分析,同時(shí),在利用三省市數(shù)據(jù)并結(jié)合醫(yī)療保險(xiǎn)相關(guān)理論分析的基礎(chǔ)上,有針對(duì)性的提出了京津滬醫(yī)療保險(xiǎn)存在的共性問題：就診流向不合理、城鄉(xiāng)醫(yī)保制度仍缺乏銜接、基金結(jié)余率高于合理化水平和醫(yī)療保險(xiǎn)經(jīng)辦管理能力有待提升以及具有各自特色的差異性問題。第三,通過深入研究發(fā)現(xiàn),醫(yī)療保險(xiǎn)支付方式不合理；城鄉(xiāng)醫(yī)�；I資標(biāo)準(zhǔn)、保障待遇上存在差距；醫(yī)�；鹬Ц稒C(jī)制過于謹(jǐn)慎,公眾享受的醫(yī)保待遇普遍過低；醫(yī)保經(jīng)辦機(jī)構(gòu)管理不統(tǒng)一,現(xiàn)有工作人員編制靈活性差；政府職能不到位,財(cái)政投入不足是形成上述問題的原因。最后,在以上分析的基礎(chǔ)上,總結(jié)了京津滬三地醫(yī)療保險(xiǎn)實(shí)施過程中的有益經(jīng)驗(yàn)和問題原因,并同時(shí)結(jié)合了國(guó)外四種主流醫(yī)療保險(xiǎn)模式經(jīng)驗(yàn)啟示,提出完善我國(guó)基本醫(yī)療保險(xiǎn)制度的政策建議：完善醫(yī)保支付方式、健全不同醫(yī)保制度銜接機(jī)制、加大對(duì)醫(yī)療保險(xiǎn)基金的監(jiān)督、適當(dāng)引入市場(chǎng)機(jī)制經(jīng)辦基本醫(yī)療保險(xiǎn)、以及明確各級(jí)政府定位等。
[Abstract]:At the end of the 90s of last century, China began to reform the basic medical insurance system for urban workers and workers in cities and towns. In 2003, China began to carry out a new rural cooperative medical system in rural areas. In 2007, the basic medical insurance system for urban residents (non practitioners) began to be tested. At present, our country has initially formed the whole urban and rural residents. However, due to the imbalance of the regional economic development, the medical security treatment gap between urban and rural residents is large, and the medical insurance benefits of the residents in different regions are very big. Even in the same area, the medical insurance treatment of the residents in different forms of employment is not exhausted. On the basis of China's national conditions, how to find out the main problems of basic medical insurance in our country, find out the fundamental causes of the related problems and establish a medical insurance system with fairness and efficiency, which has become an important subject in the medical insurance system of our country.
This article mainly uses the methods of literature analysis, content analysis and comparative analysis, taking the three areas of Beijing, Tianjin and Shanghai as the sample area. First, it systematically combs and compares the differences in the medical insurance model and the development of the three places in Beijing, Tianjin and Shanghai. The analysis found that the three places in Beijing, Tianjin and Shanghai are in the implementation model of the medical insurance because of the economic development situation and other factors. There is a slight difference in the direction and direction of development. Beijing focuses on the construction of the medical insurance system. Tianjin focuses on the integration of urban and rural medical insurance and the unification of the management department. Shanghai focuses on the development of medical insurance in the whole city (not divided into household registration and native place). Second, the coverage of the population, the status of insurance, the financing mechanism and level, and the protection of treatment, respectively. The four aspects of the medical insurance in Beijing, Tianjin and Shanghai were compared and analyzed. The basic medical insurance of urban workers, the basic medical insurance of urban residents and the three kinds of medical insurance system in the new rural cooperative medical system were compared and analyzed. At the same time, the basic medical insurance system of the three provinces and cities was used to analyze the basis of the theory of medical insurance. On the other hand, the common problems in Beijing, Tianjin and Shanghai medical insurance are put forward: the flow of medical treatment is not reasonable, the medical insurance system in urban and rural areas is still lack of cohesion, the rate of fund surplus is higher than the level of rationalization and the management ability of medical insurance management needs to be promoted as well as the differential questions with its own characteristics. Third, medical insurance is found through in-depth research and medical insurance. The way of payment is unreasonable; there is a gap in the financing standard of medical insurance in urban and rural areas; the payment mechanism of the medical insurance fund is too cautious, the medical insurance treatment of the public is generally too low; the management of the medical insurance agencies is not unified, the flexibility of the existing staff is poor; the government functions are not in position and the financial input is insufficient to form the above problems original Finally, on the basis of the above analysis, it summarizes the beneficial experience and the cause of the implementation of the three places medical insurance in Beijing, Tianjin and Shanghai. At the same time, it combines the experience of the four mainstream medical insurance modes in foreign countries, and puts forward some suggestions to improve the basic medical insurance system in China: to perfect the way of medical insurance payment and to improve the medical insurance system. We should strengthen the supervision of medical insurance funds, introduce market mechanism to handle basic medical insurance, and define the position of governments at all levels.

【學(xué)位授予單位】：北京交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：F842.684

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