發(fā)布時(shí)間：2018-10-31 19:41

【摘要】：改革和完善社會(huì)保障制度是新形勢下社會(huì)發(fā)展的客觀要求和必然趨勢，醫(yī)療保險(xiǎn)是社會(huì)保障體系中的重要內(nèi)容。近幾年來，醫(yī)療保險(xiǎn)制度迅速發(fā)展的同時(shí)也帶來了一系列的問題，一方面醫(yī)療費(fèi)用迅速增長，另一方面給付水平仍然較低，因此，如何合理的調(diào)整醫(yī)療保險(xiǎn)的給付水平將是一個(gè)重要的研究課題。醫(yī)療保險(xiǎn)是指以保險(xiǎn)合同約定的醫(yī)療行為的發(fā)生為給付條件的，為被保險(xiǎn)人在接受診療期間所發(fā)生的醫(yī)療費(fèi)用提供保障的保險(xiǎn)。社會(huì)醫(yī)療保險(xiǎn)是國家通過立法形式強(qiáng)制實(shí)施的，當(dāng)被保險(xiǎn)人因疾病接受醫(yī)療服務(wù)時(shí)按照規(guī)定進(jìn)行的一種經(jīng)濟(jì)補(bǔ)償制度。由于商業(yè)醫(yī)療保險(xiǎn)在遼寧省實(shí)施的范圍有限，所以本文研究的為社會(huì)醫(yī)療保險(xiǎn)。 遼寧省從2000年開始相繼建立了城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)醫(yī)療、新型農(nóng)村合作醫(yī)療保險(xiǎn)、城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)制度，經(jīng)過近十年的發(fā)展，醫(yī)療保險(xiǎn)制度取得了長足的進(jìn)步。但在醫(yī)療保險(xiǎn)的具體實(shí)施過中，保險(xiǎn)給付水平低、基金收支不平衡、醫(yī)療保險(xiǎn)的補(bǔ)償機(jī)制不完善等現(xiàn)象依然存在，特別是近幾年，醫(yī)療費(fèi)用逐年增長，“以藥養(yǎng)醫(yī)”的局面仍然存在，老百姓“看病難、看病貴”的問題也并沒有得到解決，這些問題的發(fā)生嚴(yán)重制約著我省醫(yī)療保險(xiǎn)制度的發(fā)展和完善。要想解決以上問題，首先要明確我省目前的醫(yī)療保險(xiǎn)給付水平是多少，社會(huì)統(tǒng)籌和個(gè)人賬戶的金額能支付的比例是多少；其次要知道目前的這種給付水平與我們的籌資是否匹配；最后要有針對性的提出問題的建議。因此通過對遼寧省目前醫(yī)療保險(xiǎn)給付水平的比較分析，找出我給付水平存在的問題，并如何在基金容許的范圍內(nèi)適當(dāng)提高給付水平，并將是本文需要著重解決的問題。 本文主要采用定性研究和定量研究相結(jié)合的方式，從遼寧省醫(yī)療保險(xiǎn)給付水平的實(shí)際情況出發(fā)，對醫(yī)療保險(xiǎn)制度進(jìn)行簡單的總結(jié)和歸納，，采用定量的分析方法對遼寧省現(xiàn)有的醫(yī)療保險(xiǎn)的給付水平進(jìn)行測算，著重分析了在現(xiàn)有水平下所提供的醫(yī)療保險(xiǎn)實(shí)際給付水平，并將其與籌資水平下應(yīng)提供的給付水平進(jìn)行比較，找出二者的差距。通過對世界上典型國家的醫(yī)療保險(xiǎn)給付水平的比較和分析，結(jié)合遼寧省的實(shí)際情況，提出相應(yīng)的對策及建議，進(jìn)一步促進(jìn)醫(yī)療保險(xiǎn)的完善和發(fā)展。
[Abstract]:Reforming and perfecting the social security system is the objective requirement and inevitable trend of social development under the new situation. Medical insurance is an important content in the social security system. In recent years, the rapid development of the medical insurance system has also brought about a series of problems. On the one hand, the medical costs are increasing rapidly, on the other hand, the level of payment is still relatively low. How to adjust the payment level of medical insurance is an important research topic. Medical insurance refers to the insurance that takes the occurrence of medical behavior as the condition of payment and provides the insurance for the medical expenses incurred by the insured during the period of diagnosis and treatment. Social medical insurance is a kind of economic compensation system when the insured receives medical service because of illness. Because the scope of commercial medical insurance in Liaoning Province is limited, this paper studies social medical insurance. Since 2000, Liaoning Province has established the basic medical insurance system for urban workers, the new rural cooperative medical insurance system and the basic medical insurance system for urban residents. After nearly ten years of development, the medical insurance system has made great progress. However, in the specific implementation of medical insurance, the level of insurance payment is low, the fund income and expenditure are unbalanced, the compensation mechanism of medical insurance is not perfect and so on. Especially in recent years, the medical expenses have increased year by year. The situation of "raising medicine with medicine" still exists, and the common people's problem of "difficult to see a doctor, expensive to see a doctor" has not been solved, and the occurrence of these problems has seriously restricted the development and perfection of medical insurance system in our province. Want to solve above problem, want to clear our province current medical treatment insurance to pay level first, the amount that social overall planning and individual account can pay is what proportion; Second, we need to know whether the current payment level and our funding match, and finally to put forward targeted suggestions. Therefore, through the comparative analysis of the current level of medical insurance benefits in Liaoning Province, we can find out the problems existing in our payment level, and how to properly raise the level of payment within the scope allowed by the fund, which will be the problem this paper needs to focus on. This article mainly uses the qualitative research and the quantitative research the way, from Liaoning Province medical insurance payment level actual situation, carries on the simple summary and the induction to the medical insurance system, The quantitative analysis method is used to measure the payment level of the medical insurance in Liaoning Province, and the actual level of the medical insurance provided at the present level is emphatically analyzed. And compare it with the level of payment under the level of financing, and find out the gap between them. Through the comparison and analysis of the level of medical insurance payment in typical countries in the world, combined with the actual situation in Liaoning Province, the corresponding countermeasures and suggestions are put forward to further promote the improvement and development of medical insurance.
【學(xué)位授予單位】：遼寧大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：F842.684

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