【摘要】：隨著我國(guó)經(jīng)濟(jì)的快速發(fā)展,人民生活水平的穩(wěn)步提升,人們對(duì)身體健康和生存質(zhì)量的要求越來(lái)越高,醫(yī)療費(fèi)用也日益增長(zhǎng),居民個(gè)人負(fù)擔(dān)隨之增加,因病致貧、因病返貧的情況時(shí)有發(fā)生。基本醫(yī)療保險(xiǎn)是涉及人民群眾切身利益的重要問(wèn)題,受到黨中央及全社會(huì)的關(guān)注和重視。我國(guó)現(xiàn)行基本醫(yī)療保險(xiǎn)制度體系,由城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)制度、城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)制度和新型農(nóng)村合作醫(yī)療制度構(gòu)成。這三項(xiàng)制度雖然在政策層面已幾乎達(dá)到覆蓋全民,但其在統(tǒng)籌層次、籌資方式、基金管理、參保原則、繳費(fèi)水平、保障程度等方面存在著巨大的差別,不能體現(xiàn)公平性,存在統(tǒng)籌層次低、醫(yī)療資源分配不合理、保障水平低、管理機(jī)構(gòu)林立、行政成本高的弊端,引起了廣大民眾的不滿,不利于基本醫(yī)療保險(xiǎn)制度持續(xù)穩(wěn)定的運(yùn)行和發(fā)展。本文遵循發(fā)現(xiàn)問(wèn)題、分析問(wèn)題、解決問(wèn)題的思路,以北京市基本醫(yī)療保險(xiǎn)制度為研究對(duì)象,以羅爾斯的公平理論、庇古的福利經(jīng)濟(jì)學(xué)理論和貝弗里奇模式理論為指導(dǎo),通過(guò)文獻(xiàn)分析法和比較研究法,分析了北京市基本醫(yī)療保險(xiǎn)制度分立的現(xiàn)狀,總結(jié)了造成分立局面的歷史、經(jīng)濟(jì)、政策原因,并從保險(xiǎn)覆蓋不全面、報(bào)銷原則不一致、付費(fèi)方式不統(tǒng)一、就醫(yī)限制不同、經(jīng)辦機(jī)構(gòu)重復(fù)設(shè)立等方面論證了基本醫(yī)療保險(xiǎn)制度進(jìn)行一體化改革的必要性。本文選取英國(guó)和荷蘭為例,介紹其基本醫(yī)療保險(xiǎn)制度的內(nèi)容以及變革歷程,英國(guó)是自建立之初就確定統(tǒng)一制度的典型,而荷蘭是由分立的基本醫(yī)療保險(xiǎn)制度改革成一體化制度的比較成功的案例,都具有一定的代表性,其先進(jìn)經(jīng)驗(yàn)對(duì)我國(guó)基本醫(yī)療保險(xiǎn)制度的一體化改革有很大的借鑒意義。本文提出了分階段實(shí)現(xiàn)北京市基本醫(yī)療保險(xiǎn)制度一體化改革的方案,第一階段,實(shí)現(xiàn)各險(xiǎn)種內(nèi)不同參保類型的統(tǒng)一;第二階段,實(shí)現(xiàn)不同險(xiǎn)種間制度的統(tǒng)一�；踞t(yī)療保險(xiǎn)制度一體化的實(shí)現(xiàn)對(duì)于我國(guó)保障人才自由流動(dòng)、保險(xiǎn)待遇的順利銜接、勞動(dòng)力的保護(hù)和供給、保障公平性上有巨大意義,也能解決我國(guó)目前基本醫(yī)療保險(xiǎn)統(tǒng)籌層次低、抗擊風(fēng)險(xiǎn)能力弱、保障水平低、行政成本高的弊端。
[Abstract]:With the rapid development of our country's economy and the steady improvement of people's living standard, people's demands on health and quality of life are becoming higher and higher, the medical expenses are also increasing day by day, and the personal burden of the residents is increasing, resulting in poverty due to illness. The return to poverty from illness occurs from time to time. The basic medical insurance is an important issue concerning the vital interests of the people, which has received the attention and attention of the CPC Central Committee and the whole society. The current basic medical insurance system in China consists of the basic medical insurance system for urban workers, the basic medical insurance system for urban residents and the new rural cooperative medical insurance system. Although these three systems have almost reached universal coverage at the policy level, there are huge differences in the overall planning level, the way of raising funds, the fund management, the principle of participating in insurance, the level of contributions, the degree of security, and so on, which cannot reflect fairness. The malpractice of low overall level, unreasonable distribution of medical resources, low level of security, numerous administrative organizations and high administrative costs has caused dissatisfaction among the general public and is not conducive to the continuous and stable operation and development of the basic medical insurance system. This paper follows the train of thought of finding problems, analyzing problems, solving problems, taking the basic medical insurance system of Beijing as the research object, taking Rawls' theory of fairness, Pigou's theory of welfare economics and Beveridge's model theory as the guidance. Through the method of literature analysis and comparative research, this paper analyzes the present situation of the separation of basic medical insurance system in Beijing, summarizes the historical, economic and policy reasons for the separation, and analyzes the reasons for the incompleteness of insurance coverage and inconsistent reimbursement principles. The necessity of the integration reform of the basic medical insurance system is demonstrated in the aspects of different payment methods, different medical access restrictions and repeated establishment of the agencies. This paper takes Britain and the Netherlands as examples to introduce the content and reform process of the basic health insurance system. The United Kingdom is a typical example of establishing a unified system since the beginning of its establishment. The Netherlands is a relatively successful case from a separate basic medical insurance system to an integrated system, which has certain representativeness, and its advanced experience has great reference significance for the integration reform of our country's basic medical insurance system. This paper puts forward a scheme to realize the integration reform of the basic medical insurance system in Beijing in stages. In the first stage, the unification of different types of insurance is realized within the different types of insurance, and the second stage, the unification of the system among different kinds of insurance is realized. The realization of the integration of the basic medical insurance system is of great significance in ensuring the free flow of talents, the smooth convergence of insurance treatment, the protection and supply of labor force, and the guarantee of fairness in our country. It can also solve the problems of low overall level of basic medical insurance, weak ability of resisting risk, low level of security and high administrative cost.
【學(xué)位授予單位】：首都經(jīng)濟(jì)貿(mào)易大學(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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