【摘要】：隨著時(shí)代和經(jīng)濟(jì)的發(fā)展,我國城鄉(xiāng)、區(qū)域發(fā)展失衡,城鄉(xiāng)發(fā)展差距不斷加大,社會(huì)矛盾尖銳嚴(yán)重阻礙了社會(huì)穩(wěn)定和經(jīng)濟(jì)發(fā)展的速度。人們對(duì)醫(yī)療衛(wèi)生服務(wù)的需求加大,對(duì)醫(yī)保的需求層次變得多樣化,對(duì)公平的醫(yī)療服務(wù)呼聲變高,落后的醫(yī)保配套措施,難以滿足群眾的需求。建立與經(jīng)濟(jì)發(fā)展相適應(yīng)的城鄉(xiāng)醫(yī)療保險(xiǎn)制度也應(yīng)隨之發(fā)生變化。現(xiàn)行的醫(yī)療保險(xiǎn)制度在運(yùn)行過程中出現(xiàn)“碎片化”、“多元化”的特征。具體在實(shí)踐過程中表現(xiàn)為:城鄉(xiāng)居民待遇差距較大,城鄉(xiāng)居民醫(yī)保出現(xiàn)銜接困難,待遇不公平等問題。隨著工業(yè)化和城市化的推進(jìn),戶籍制度被打破,人口流動(dòng)和結(jié)構(gòu)的變化,需要建立與之配套的醫(yī)療保險(xiǎn)制度。本文通過對(duì)相關(guān)文獻(xiàn)和具體實(shí)例進(jìn)行分析,通過對(duì)基本理論的梳理,運(yùn)用文獻(xiàn)分析法和對(duì)比分析法對(duì)云南省現(xiàn)行的城鎮(zhèn)職工醫(yī)療保險(xiǎn)、城鎮(zhèn)居民醫(yī)療保險(xiǎn)、新農(nóng)合政策進(jìn)行綜合研究,對(duì)醫(yī)療保險(xiǎn)改革的具體政策進(jìn)行理論和實(shí)踐分析。現(xiàn)行的醫(yī)療保險(xiǎn)制度由于制度設(shè)計(jì)不合理、籌資手段不足、資金監(jiān)管措施不到位,實(shí)施程序不公平,嚴(yán)重阻礙了經(jīng)濟(jì)的發(fā)展。對(duì)醫(yī)療保障機(jī)制進(jìn)行整合和政策銜接是社會(huì)發(fā)展的必然要求。云南省位于經(jīng)濟(jì)不發(fā)達(dá)的西部地區(qū),地區(qū)經(jīng)濟(jì)發(fā)展不均衡,本地醫(yī)療保險(xiǎn)政策在實(shí)施中也遇到了種種困難,對(duì)于醫(yī)保統(tǒng)籌銜接機(jī)制更是需要進(jìn)行整體化研究。具體的醫(yī)保政策在實(shí)施的過程中需要按照循序漸進(jìn)的原則進(jìn)行,因地制宜的出臺(tái)具體的政策建議,不能籠統(tǒng)的按照一個(gè)模式進(jìn)行下去。因此,探尋一個(gè)適合云南省城鄉(xiāng)醫(yī)保的政策銜接機(jī)制就顯得尤為重要了。本文通過對(duì)云南省城鄉(xiāng)居民醫(yī)療保險(xiǎn)的主要制度實(shí)施的模式、運(yùn)行的基本狀況,存在的問題以及我國城鄉(xiāng)居民醫(yī)�，F(xiàn)狀進(jìn)行分析。針對(duì)醫(yī)療保險(xiǎn)統(tǒng)籌銜接機(jī)制實(shí)施過程中出現(xiàn)的問題進(jìn)行研究,通過對(duì)醫(yī)改實(shí)施比較成功的地區(qū),如上海市、安徽省寧國市、重慶市醫(yī)保統(tǒng)籌整合銜接機(jī)制建設(shè)的成功經(jīng)驗(yàn)進(jìn)行典型研究。著力厘清云南省統(tǒng)籌城鄉(xiāng)居民醫(yī)療保險(xiǎn)制度,對(duì)分散的體制進(jìn)行整合研究,指出推進(jìn)制度一體化建設(shè)的必要性與可行性。針對(duì)整合銜接過程中出現(xiàn)的問題分析原因,通過借鑒各試點(diǎn)地區(qū)取得的成功經(jīng)驗(yàn),提出具體的解決措施和意見。并就云南省醫(yī)保統(tǒng)籌銜接機(jī)制建設(shè)的制度模式和路徑選擇提出相應(yīng)的對(duì)策建議。
[Abstract]:With the development of times and economy, the imbalance of urban and rural development and regional development in China, the increasing gap between urban and rural development, the sharp social contradictions seriously hinder the social stability and the speed of economic development. People's demand for medical and health services has increased, the demand for medical insurance has become diversified, the demand for fair medical services has become higher, and the backward matching measures of medical insurance are difficult to meet the needs of the masses. The establishment of urban and rural medical insurance system in accordance with economic development should also change with it. The current medical insurance system is characterized by fragmentation and diversification. In the process of practice, the difference of treatment between urban and rural residents is large, the medical insurance of urban and rural residents is difficult to link up, the treatment is unfair and so on. With the development of industrialization and urbanization, the household registration system has been broken, and the population flow and structure have changed, so it is necessary to establish a matching medical insurance system. Through the analysis of relevant documents and concrete examples, through combing the basic theory, using the literature analysis method and the comparative analysis method, this paper analyzes the current medical insurance of urban workers and urban residents in Yunnan Province. The new rural cooperative policy carries on the comprehensive research, carries on the theory and the practice analysis to the medical insurance reform concrete policy. The current medical insurance system is seriously hindered by the unreasonable design of the system, insufficient means of financing, inadequate supervision of funds and unfair implementation procedures. The integration of medical security mechanism and policy convergence is the inevitable requirement of social development. Yunnan Province is located in the underdeveloped western region, the regional economic development is not balanced, the local medical insurance policy has also encountered a variety of difficulties in the implementation of the medical insurance system is even more necessary to carry out a holistic study. The specific medical insurance policy in the process of implementation needs to be carried out in accordance with the principle of gradual and orderly, according to local conditions, the introduction of specific policy recommendations, can not be carried out in general according to a model. Therefore, it is particularly important to explore a policy convergence mechanism suitable for urban and rural health insurance in Yunnan Province. This paper analyzes the mode of implementing the main system of medical insurance for urban and rural residents in Yunnan Province, the basic status of operation, the existing problems and the present situation of medical insurance of urban and rural residents in China. Based on the study of the problems in the implementation of the medical insurance linkage mechanism, through the implementation of the more successful areas of medical reform, such as Shanghai, Ningguo City, Anhui Province, The successful experience in the construction of the medical insurance system in Chongqing is studied. This paper makes great efforts to clarify the medical insurance system of urban and rural residents in Yunnan Province, studies the decentralized system, and points out the necessity and feasibility of promoting the construction of institutional integration. This paper analyzes the causes of the problems in the process of integration and cohesion, and puts forward some concrete measures and suggestions through drawing lessons from the successful experiences of each pilot area. And put forward the corresponding countermeasures and suggestions on the institutional model and path selection of the construction of the overall linking mechanism of health insurance in Yunnan Province.
【學(xué)位授予單位】：云南財(cái)經(jīng)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

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本文編號(hào)：2269969