【摘要】：在我國(guó)經(jīng)濟(jì)社會(huì)日益發(fā)達(dá)的今天,人民群眾對(duì)于個(gè)人健康生活的訴求不斷提高,然而我國(guó)現(xiàn)有的基本醫(yī)療保險(xiǎn)的覆蓋范圍和保障水平相對(duì)有限。對(duì)于罹患重大疾病的人民群眾,自身往往需要負(fù)擔(dān)較大比例的醫(yī)療費(fèi)用,因病致貧和返貧現(xiàn)象時(shí)有發(fā)生。這違背了我國(guó)到2020年解決貧困問(wèn)題和全面建成小康社會(huì)的總體部署。在此背景下,我國(guó)于2012年開始全面推進(jìn)大病保險(xiǎn)制度的相關(guān)建設(shè),目前已在全國(guó)所有省區(qū)和直轄市開展試點(diǎn),且部分地區(qū)已經(jīng)全面鋪開相關(guān)工作。但在實(shí)際操作中,缺乏相關(guān)理論指導(dǎo),存在諸多問(wèn)題,需要盡快研究解決。基于以上原因,本文對(duì)我國(guó)的大病保險(xiǎn)制度進(jìn)行了全面研究:首先梳理了現(xiàn)有的相關(guān)文獻(xiàn);在此基礎(chǔ)上,對(duì)我國(guó)的基本醫(yī)療保障體系和大病的概念作出界定,并從運(yùn)行模式、籌資機(jī)制、保障水平、承保方式和監(jiān)督管控五方面對(duì)我國(guó)大病保險(xiǎn)制度做了論述,著重使用準(zhǔn)公共產(chǎn)品理論、福利多元主義理論、公共外包理論和公共選擇理論對(duì)我國(guó)的大病保險(xiǎn)制度進(jìn)行經(jīng)濟(jì)學(xué)屬性分析;接著介紹了國(guó)內(nèi)地區(qū)(湛江市、太倉(cāng)市和廈門市)的大病保險(xiǎn)制度實(shí)施背景和實(shí)施效果,從政策制定、籌資方式和保障效果等方面對(duì)其優(yōu)勢(shì)和不足進(jìn)行分析;然后將國(guó)外醫(yī)療保險(xiǎn)模式分為社會(huì)醫(yī)療保險(xiǎn)模式、國(guó)家健康保險(xiǎn)模式、儲(chǔ)蓄醫(yī)療保險(xiǎn)模式和商業(yè)醫(yī)療保險(xiǎn)模式四種,并以德國(guó)、英國(guó)、新加坡和美國(guó)作為代表進(jìn)行了闡述,分析其運(yùn)行模式和優(yōu)缺點(diǎn);最后,對(duì)完善我國(guó)的大病保險(xiǎn)制度提出了六點(diǎn)政策建議,分別是建立多渠道的動(dòng)態(tài)籌資機(jī)制、構(gòu)建大病保險(xiǎn)信息服務(wù)平臺(tái)、完善政企風(fēng)險(xiǎn)公擔(dān)機(jī)制、加速醫(yī)藥衛(wèi)生領(lǐng)域改革進(jìn)程和增強(qiáng)居民預(yù)防保健意識(shí)。
[Abstract]:With the development of our country's economy and society, the people's demands for a healthy personal life are increasing. However, the coverage and security level of the existing basic medical insurance are relatively limited in our country. For the people suffering from major diseases, they often have to bear a large proportion of medical expenses, and the phenomenon of poverty and return to poverty occur from time to time. This runs counter to the overall plan of solving the poverty problem and building a well-off society in an all-round way by 2020. In this context, in 2012, China began to comprehensively promote the serious illness insurance system related to the construction, has been in all provinces and municipalities in the country to pilot, and some areas have been fully spread out the relevant work. However, in practice, there are many problems in the lack of theoretical guidance, which need to be solved as soon as possible. Based on the above reasons, this paper has carried on the comprehensive research to our country's serious illness insurance system: firstly, has combed the existing related literature; On this basis, the basic medical security system and the concept of serious illness in China are defined, and the insurance system of our country is discussed from five aspects: the operating mode, the financing mechanism, the level of security, the way of underwriting, the supervision and control. This paper focuses on the use of quasi-public product theory, welfare pluralism theory, public outsourcing theory and public choice theory to analyze the economic attributes of China's serious illness insurance system. Then it introduces the background and effect of the serious illness insurance system in China (Zhanjiang City, Taicang City and Xiamen City), and analyzes its advantages and disadvantages from the aspects of policy formulation, financing method and guarantee effect. Then the foreign medical insurance model is divided into social medical insurance model, national health insurance model, savings medical insurance model and commercial medical insurance model, which are represented by Germany, Britain, Singapore and the United States. Analyze its operation mode, advantages and disadvantages; Finally, six policy suggestions are put forward to perfect our country's serious illness insurance system, which are to establish a multi-channel dynamic financing mechanism, to construct a platform of information service for serious illness insurance, and to perfect the mechanism of government and enterprise risk sharing. We will speed up the reform process in the field of medicine and health care and enhance the awareness of prevention and health care among the residents.
【學(xué)位授予單位】：廣西大學(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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