【摘要】：在人類面臨的諸多風(fēng)險(xiǎn)中,疾病風(fēng)險(xiǎn)是涉及面廣、復(fù)雜多樣、危害嚴(yán)重、直接關(guān)系到人類基本生存的特殊風(fēng)險(xiǎn)。醫(yī)療保障是一項(xiàng)基本的社會(huì)保障。任何國(guó)家的居民都將面臨疾病風(fēng)險(xiǎn)以及與疾病風(fēng)險(xiǎn)有關(guān)的醫(yī)療服務(wù)、醫(yī)療保險(xiǎn)等問(wèn)題。人的一生可以躲過(guò)失業(yè)風(fēng)險(xiǎn),躲過(guò)意外傷害的風(fēng)險(xiǎn),但誰(shuí)也躲不過(guò)老和病。對(duì)此,許多國(guó)家把保障國(guó)民健康規(guī)定在憲法中,并提出具體的目標(biāo)和原則,形成了自己的社會(huì)醫(yī)療保障體系。由政府組織實(shí)施覆蓋全體人民的基本醫(yī)療保險(xiǎn),是現(xiàn)代國(guó)家的通行制度,是公民享有的基本權(quán)利。適宜的社會(huì)醫(yī)療保障制度是維護(hù)居民健康狀況,提高生活質(zhì)量,促進(jìn)社會(huì)經(jīng)濟(jì)發(fā)展的根本保障。本文通過(guò)對(duì)青島市城鎮(zhèn)基本醫(yī)療保險(xiǎn)管理的實(shí)證分析,總結(jié)出青島市城鎮(zhèn)基本醫(yī)療保險(xiǎn)模式,并進(jìn)行一些理論上的思考。 首先通過(guò)總結(jié)國(guó)內(nèi)外關(guān)于醫(yī)療保險(xiǎn)管理的相關(guān)研究,在此基礎(chǔ)上明確了研究目的和研究意義,構(gòu)建了本文研究的基本思路、研究方法和研究框架和內(nèi)容。其次,概述了青島市城鎮(zhèn)基本醫(yī)療保險(xiǎn)的基本情況,主要包括青島市城鎮(zhèn)職工、居民基本醫(yī)療保險(xiǎn)制度框架和主要政策。第三,總結(jié)青島市城鎮(zhèn)基本醫(yī)療保險(xiǎn)模式及成功經(jīng)驗(yàn)。青島市城鎮(zhèn)基本醫(yī)療保險(xiǎn)主要是以“三個(gè)目錄、兩個(gè)定點(diǎn)、一個(gè)結(jié)算辦法”為核心的管理模式,在十多年的管理實(shí)踐中,城鎮(zhèn)基本醫(yī)療保險(xiǎn)覆蓋人數(shù)迅速增加·,醫(yī)療保障能力持續(xù)增強(qiáng),醫(yī)療保障待遇水平穩(wěn)步提高,醫(yī)療保險(xiǎn)管理政策體系逐步完善。第四,在總結(jié)青島市城鎮(zhèn)基本醫(yī)療保險(xiǎn)模式及成功經(jīng)驗(yàn)的基礎(chǔ)上,提出青島市城鎮(zhèn)基本醫(yī)療保險(xiǎn)存在的問(wèn)題及解決對(duì)策建議,應(yīng)不斷完善支付辦法,實(shí)現(xiàn)醫(yī)�；鸱�(wěn)健運(yùn)行；繼續(xù)推進(jìn)門診統(tǒng)籌,加快醫(yī)療保險(xiǎn)向社區(qū)轉(zhuǎn)移；探索完善各項(xiàng)機(jī)制,降低基金支出,強(qiáng)化誠(chéng)信醫(yī)保建設(shè)。 通過(guò)對(duì)青島市城鎮(zhèn)基本醫(yī)療保險(xiǎn)模式進(jìn)行分析研究,將進(jìn)一步推動(dòng)青島市的醫(yī)療保障工作在維護(hù)參保人權(quán)益、促進(jìn)全市經(jīng)濟(jì)發(fā)展和社會(huì)穩(wěn)定方面發(fā)揮更積極的作用。
[Abstract]:Among the many risks faced by human beings, the risk of disease is a special risk that involves a wide range of areas, is complex and diverse, and has serious harm, which is directly related to the basic survival of human beings. Medical security is a basic social security. Residents of any country will face disease risk and health care, health insurance and other issues related to disease risk. One can avoid unemployment risk and accidental injury risk in one's life, but no one can escape old age and illness. In this regard, many countries put the provision of national health protection in their constitutions, and put forward specific goals and principles, forming their own social medical security system. The basic medical insurance which covers all the people by the government is the current system of the modern country and the basic right enjoyed by the citizens. The proper social medical security system is the fundamental guarantee to maintain the residents' health condition, improve the quality of life and promote the social and economic development. Based on the empirical analysis of the management of basic medical insurance in Qingdao, this paper sums up the mode of basic medical insurance in Qingdao, and makes some theoretical considerations. Firstly, by summarizing the relevant research on medical insurance management at home and abroad, the purpose and significance of the research are clarified, and the basic ideas, research methods, research framework and contents of this paper are constructed. Secondly, it summarizes the basic situation of the basic medical insurance in Qingdao, mainly including the framework and main policies of the basic medical insurance system for the urban workers and residents in Qingdao. Third, summarize the basic medical insurance model and successful experience of Qingdao. Qingdao's basic medical insurance in cities and towns is mainly based on the "three catalogs, two fixed points, one settlement method" as the core management model. In more than ten years of management practice, the number of people covered by the basic medical insurance in cities and towns has increased rapidly. The ability of medical insurance has been continuously strengthened, the level of medical insurance treatment has been steadily improved, and the policy system of medical insurance management has been gradually improved. Fourth, on the basis of summing up the basic medical insurance mode and successful experience of Qingdao city, the paper puts forward the problems and countermeasures of the basic medical insurance in Qingdao, which should improve the payment method and realize the steady operation of the medical insurance fund. We will continue to promote out-patient coordination, speed up the transfer of medical insurance to the community, explore and improve various mechanisms, reduce fund expenditures, and strengthen the construction of health insurance in good faith. Through the analysis and research on the basic medical insurance model of Qingdao city, it will further promote the medical security work in Qingdao to play a more active role in safeguarding the rights and interests of the insured and promoting the economic development and social stability of the whole city.
【學(xué)位授予單位】：中國(guó)海洋大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：F842.684

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 邱曉丹;深圳市與加拿大現(xiàn)行醫(yī)療保險(xiǎn)模式的比較研究[J];特區(qū)經(jīng)濟(jì);1994年08期

2 李國(guó)鴻,朱雪奇;韓國(guó)醫(yī)療保險(xiǎn)模式的發(fā)展與剖析[J];國(guó)外醫(yī)學(xué)(衛(wèi)生經(jīng)濟(jì)分冊(cè));1996年01期

3 黃煒,申曙光;美國(guó)特有的一種醫(yī)療保險(xiǎn)模式介紹[J];保險(xiǎn)研究;2002年03期

4 王芳,程茂金,王紅;探索我國(guó)農(nóng)村流動(dòng)人口醫(yī)療保險(xiǎn)模式[J];中國(guó)公共衛(wèi)生;2003年01期

5 李瓊 ,張潤(rùn)暉 ,朱華琳;國(guó)外醫(yī)療保險(xiǎn)模式選擇[J];中國(guó)保險(xiǎn);2003年05期

6 李素娜;楊光;;我區(qū)農(nóng)村合作醫(yī)療保險(xiǎn)模式的探討[J];農(nóng)村科技;2003年02期

7 李國(guó)鴻 ,金安娜;韓國(guó)醫(yī)療保險(xiǎn)模式的特點(diǎn)與評(píng)價(jià)[J];國(guó)外醫(yī)學(xué)(衛(wèi)生經(jīng)濟(jì)分冊(cè));2004年01期

8 賴潔蓮;建立農(nóng)村大病統(tǒng)籌醫(yī)療保險(xiǎn)模式的可行性分析[J];廣東行政學(xué)院學(xué)報(bào);2004年03期

9 李國(guó)鴻;加拿大醫(yī)療保險(xiǎn)模式及其發(fā)展評(píng)析[J];國(guó)外醫(yī)學(xué)(衛(wèi)生經(jīng)濟(jì)分冊(cè));2005年01期

10 萬(wàn)筱明;;國(guó)外醫(yī)療保險(xiǎn)模式借鑒研究[J];上海保險(xiǎn);2007年04期

相關(guān)會(huì)議論文 前1條

1 郭翔宇;劉軍;李紅娟;趙冬;;中國(guó)常見醫(yī)療保險(xiǎn)模式與門診高血壓患者血壓控制[A];第十三次全國(guó)心血管病學(xué)術(shù)會(huì)議論文集[C];2011年

相關(guān)重要報(bào)紙文章 前3條

1 馮鵬程;新加坡：儲(chǔ)蓄醫(yī)療保險(xiǎn)模式下的稅優(yōu)政策[N];中國(guó)保險(xiǎn)報(bào);2014年

2 據(jù)勞動(dòng)和社會(huì)保障部社會(huì)保險(xiǎn)事業(yè)管理中心;發(fā)達(dá)國(guó)家的五種醫(yī)療保險(xiǎn)模式[N];中國(guó)中醫(yī)藥報(bào);2003年

3 馮鵬程;澳大利亞國(guó)家醫(yī)療保險(xiǎn)模式的稅優(yōu)政策[N];中國(guó)保險(xiǎn)報(bào);2014年

相關(guān)博士學(xué)位論文 前1條

1 陳一丹;珠海市社會(huì)醫(yī)療保險(xiǎn)模式及其對(duì)醫(yī)療費(fèi)用的影響研究[D];華中科技大學(xué);2009年

相關(guān)碩士學(xué)位論文 前7條

1 涂斯婧;以效率為導(dǎo)向的管理型醫(yī)療保險(xiǎn)模式研究[D];廣西醫(yī)科大學(xué);2012年

2 邵爽;青島市城鎮(zhèn)基本醫(yī)療保險(xiǎn)模式探析[D];中國(guó)海洋大學(xué);2013年

3 孫茜;上海市農(nóng)民工醫(yī)療保險(xiǎn)模式研究[D];安徽財(cái)經(jīng)大學(xué);2014年

4 宋廣;城鄉(xiāng)統(tǒng)籌背景下農(nóng)民工醫(yī)療保險(xiǎn)模式研究[D];河北經(jīng)貿(mào)大學(xué);2011年

5 姜瀚濱;吉林省城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)制度存在問(wèn)題與對(duì)策研究[D];東北師范大學(xué);2014年

6 文國(guó)獅;杭州市農(nóng)民工醫(yī)療保險(xiǎn)模式完善研究[D];杭州師范大學(xué);2012年

7 夏冬怡;農(nóng)民工醫(yī)療保險(xiǎn)模式優(yōu)化分析[D];遼寧大學(xué);2012年

，

本文編號(hào)：2336949