【摘要】：在我國(guó),社會(huì)醫(yī)療保險(xiǎn)制度正在全國(guó)范圍內(nèi)逐步改革和推廣,改革后的醫(yī)療保險(xiǎn)制度是否能夠?qū)崿F(xiàn)用比較合理的費(fèi)用提供比較優(yōu)質(zhì)的醫(yī)療服務(wù),從而實(shí)現(xiàn)滿足廣大群眾基本醫(yī)療服務(wù)需求的目標(biāo),既關(guān)系著廣大人民群眾的切身利益能否實(shí)現(xiàn),又關(guān)系到新的醫(yī)療保險(xiǎn)制度是否能持續(xù)運(yùn)行。 城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)作為社會(huì)醫(yī)療保險(xiǎn)制度的重要內(nèi)容,是為勞動(dòng)者在因生病而蒙受經(jīng)濟(jì)損失之后給予一定經(jīng)濟(jì)補(bǔ)償時(shí)建立的一項(xiàng)醫(yī)療保險(xiǎn)制度。城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)制度實(shí)行單位和個(gè)人按一定比例共同繳費(fèi),參保職工生病產(chǎn)生的醫(yī)療費(fèi)用由醫(yī)療保險(xiǎn)經(jīng)辦機(jī)構(gòu)通過(guò)醫(yī)療保險(xiǎn)基金給付參保人員一定的經(jīng)濟(jì)補(bǔ)償,從而減輕參保人員因生病和治療等醫(yī)療需求所承受的經(jīng)濟(jì)負(fù)擔(dān)。 在w市實(shí)行城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)以來(lái),醫(yī)療保險(xiǎn)費(fèi)用的支出也不斷上漲,醫(yī)院、患者之間的信息不對(duì)稱導(dǎo)致了道德風(fēng)險(xiǎn)的存在。如果不加強(qiáng)w市城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)費(fèi)用的控制,醫(yī)療保險(xiǎn)基金將出現(xiàn)收不抵支的狀況,這將會(huì)影響到基金的使用,城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)制度的持續(xù)發(fā)展將會(huì)受到威脅。因此,遏制w市城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)費(fèi)用的不合理增長(zhǎng)勢(shì)在必行。 本文運(yùn)用了經(jīng)濟(jì)學(xué)、統(tǒng)計(jì)學(xué)方法,從w市城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)的實(shí)際情況出發(fā),從需求方和供給方兩方面建立影響城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)費(fèi)用支出的模型。根據(jù)模型的建立和分析,并結(jié)合國(guó)外和國(guó)內(nèi)典型城市醫(yī)療保險(xiǎn)費(fèi)用控制的可借鑒經(jīng)驗(yàn),針對(duì)W市城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)費(fèi)用控制提出合理性建議,從而推進(jìn)W市城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)制度的順利實(shí)施。
[Abstract]:In China, the social medical insurance system is gradually being reformed and popularized throughout the country. Will the reformed medical insurance system be able to provide relatively high quality medical services at a more reasonable cost? Thus, the goal of meeting the basic medical service needs of the masses is not only related to whether the vital interests of the masses can be realized, but also whether the new medical insurance system can continue to operate. As an important part of the social medical insurance system, the basic medical insurance for urban workers is a medical insurance system which is established for workers when they give certain economic compensation after they have suffered economic losses due to illness. The basic medical insurance system for urban staff and workers shall be jointly paid by units and individuals in a certain proportion. The medical expenses arising from the illness of the insured workers shall be paid by the medical insurance agencies through the medical insurance fund to pay certain economic compensation to the insured personnel. Thus reducing the insured due to illness and treatment and other medical needs to bear the economic burden. Since the implementation of basic medical insurance for urban workers in w city, the expenditure of medical insurance costs has also been rising, and the asymmetric information between hospitals and patients has led to the existence of moral hazard. If we do not strengthen the control of the cost of basic medical insurance for urban staff and workers in w city, the medical insurance fund will appear the situation that the income does not exceed the expenditure, which will affect the use of the fund, and the sustainable development of the basic medical insurance system for urban workers will be threatened. Therefore, it is imperative to curb the unreasonable increase of the cost of basic medical insurance for urban workers in w city. Based on the economic and statistical methods and the actual situation of the basic medical insurance for urban workers in w city, this paper sets up a model from the demand side and the supply side, which affects the expenditure of the basic medical insurance expenses of the urban workers. According to the establishment and analysis of the model, combined with the experience of medical insurance cost control in foreign and domestic typical cities, this paper puts forward some reasonable suggestions for the cost control of basic medical insurance for urban workers in W city. Thus, the implementation of the basic medical insurance system for urban workers in W City is carried out smoothly.
【學(xué)位授予單位】：西南交通大學(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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