【摘要】：20世紀(jì)80年代以及90年代早期,我國社會醫(yī)療保險支出急劇增長,建立在基本醫(yī)療保險基礎(chǔ)上的大病補(bǔ)充醫(yī)療保險項(xiàng)目賠付控制已經(jīng)成為商業(yè)保險公司必須面臨的課題。 本文以S區(qū)大病補(bǔ)充醫(yī)療保險項(xiàng)目賠付控制為研究對象,首先對影響國內(nèi)外醫(yī)療費(fèi)用增加因素：人口老齡化、醫(yī)療保險制度、國民收入的增加、醫(yī)療技術(shù)進(jìn)步分別進(jìn)行分析,通過對美國、英國、德國、新加坡等國家開展的社會醫(yī)療保險項(xiàng)目的啟示,找出了S區(qū)大病補(bǔ)充醫(yī)療保險項(xiàng)目賠付控制中退休人員占比過高、賬戶結(jié)余過低、人均醫(yī)療賠付支出上漲過快等三大問題,提出了s區(qū)大病補(bǔ)充醫(yī)療保險項(xiàng)目賠付控制對策,通過建立市級統(tǒng)籌、對定點(diǎn)藥店和醫(yī)療機(jī)構(gòu)的管理、信息系統(tǒng)的建設(shè)、改變支付方式和手段等方式來保障S區(qū)大病補(bǔ)充醫(yī)療保險項(xiàng)目的安全運(yùn)行。 本文通過對S區(qū)大病補(bǔ)充醫(yī)療保險項(xiàng)目賠付控制對策的研究,為商業(yè)保險公司的大病補(bǔ)充醫(yī)療保險項(xiàng)目賠付控制提供了可供參考的解決方案。
[Abstract]:In the 1980s and early 1990's, the expenditure of social medical insurance in our country increased rapidly. The compensation control of the major illness supplementary medical insurance project based on the basic medical insurance has become a subject that commercial insurance companies must face. This article takes the S area serious illness supplementary medical insurance item compensation control as the research object, first of all carries on the analysis to the influence domestic and foreign medical treatment expense increase factor: the population aging, the medical insurance system, the national income increase, the medical technology progress respectively, Through the inspiration to the social health insurance programs carried out in the United States, Britain, Germany, Singapore and other countries, it is found that the proportion of retirees and the low balance of accounts are too high and the balance of account is too low in the payment control of the supplemental medical insurance programs in the S region. Three major problems, such as the rapid increase of per capita medical compensation expenditure, have been put forward to control the compensation and payment of supplementary medical insurance items in s district. Through the establishment of municipal co-ordination, the management of designated drugstores and medical institutions, and the construction of information system, have been put forward. Change the way and means of payment to ensure the safe operation of the supplementary medical insurance project in S area. Based on the research on the compensation control strategy of the supplementary medical insurance project in S area, this paper provides a reference solution for the compensation control of the major illness supplementary medical insurance project in the commercial insurance company.
【學(xué)位授予單位】：南昌大學(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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