【摘要】：醫(yī)療保險(xiǎn)是社會(huì)保險(xiǎn)的重要組成部分，維系著人民群眾最基本的社會(huì)保障需求。新醫(yī)改以來，我國醫(yī)療保險(xiǎn)體系不斷改革深化，但是總體上看仍然存在資金使用效率有待提高、保障范圍仍有死角、保障水平參差不齊等問題，特別是對(duì)于城鎮(zhèn)居民保險(xiǎn)和新農(nóng)合的群體，往往在罹患大病的時(shí)候，面臨著因病致貧，因病返貧的經(jīng)濟(jì)風(fēng)險(xiǎn)。費(fèi)用配置、制度設(shè)計(jì)和風(fēng)險(xiǎn)控制等方面的矛盾在大病醫(yī)保體系中表現(xiàn)的尤為突出。商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)的銜接是解決這一矛盾的有效途徑。大病醫(yī)保體系中商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)的銜接研究對(duì)于建立多層次醫(yī)療保障制度、切實(shí)提高醫(yī)療保障水平、推動(dòng)公共衛(wèi)生事業(yè)發(fā)展有著非常重要的作用。 本文提出了大病醫(yī)保體系中商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)的銜接問題，首先界定了相關(guān)概念，從大病醫(yī)保的基本屬性出發(fā)，分析了大病醫(yī)保體系中政府和市場的相關(guān)作用，對(duì)比了商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)的聯(lián)系和區(qū)別，分析了兩者在大病醫(yī)保體系中的定位關(guān)系、銜接關(guān)系和相互之間關(guān)系的轉(zhuǎn)變。本文主要立足于公共政策分析的角度，綜合運(yùn)用了保險(xiǎn)學(xué)和經(jīng)濟(jì)學(xué)的經(jīng)典方法，闡明了在大病醫(yī)保體系中商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)相互銜接的必要性和可行性。 銜接研究的第二步分析了我國大病醫(yī)保制度建立的背景和基本內(nèi)容，以及當(dāng)前商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)銜接的現(xiàn)狀，，著重分析了湛江和太倉兩地的模式。指出了當(dāng)前狀況下大病醫(yī)保體系中商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)銜接過程中存在的缺陷，提出了兩者銜接過程中的三個(gè)關(guān)鍵點(diǎn)：資金籌集和給付的銜接、保障范圍的銜接和保障對(duì)象的銜接。 最后是對(duì)大病醫(yī)保體系中商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)的銜接對(duì)策進(jìn)行了研究分析。以上海市為例，設(shè)計(jì)了大病醫(yī)保體系中商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)銜接的方案，并提出了兩者銜接過程需要的內(nèi)部制度保證和外部激勵(lì)條件。 本文通過對(duì)商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)的銜接研究，從理論上解釋了大病醫(yī)保體系中商業(yè)醫(yī)療保險(xiǎn)和社會(huì)醫(yī)療保險(xiǎn)銜接的必要性、可行性，明確了兩者的定位和關(guān)系，給出了具體的銜接思路和簡單的銜接模型，為大病醫(yī)保體系下一步學(xué)術(shù)上的深入研究，乃至其中商業(yè)保險(xiǎn)和社會(huì)保險(xiǎn)銜接在政策上的實(shí)施推進(jìn)，提供了一種可以借鑒的思路。
[Abstract]:Medical insurance is an important part of social insurance, which maintains the most basic social security needs of the people. Since the new medical reform, the medical insurance system in our country has been continuously reformed and deepened, but on the whole, there are still some problems, such as the efficiency of the use of funds needs to be improved, the scope of security is still dead, and the level of security is uneven. Especially for urban residents insurance and NCMS groups, they are often faced with the economic risk of poverty caused by illness and returning to poverty because of illness. The contradiction of cost allocation, system design and risk control is particularly prominent in the serious illness medical insurance system. The connection between commercial medical insurance and social medical insurance is an effective way to solve this contradiction. The study of the connection between commercial medical insurance and social medical insurance in the medical insurance system of serious illness plays a very important role in establishing a multi-level medical security system, effectively improving the level of medical security and promoting the development of public health undertakings. This paper puts forward the connection between commercial medical insurance and social medical insurance in the serious illness medical insurance system, first defines the related concepts, and analyzes the related functions of the government and the market in the serious illness medical insurance system from the basic attributes of the serious illness medical insurance. This paper compares the relationship and difference between commercial medical insurance and social medical insurance, and analyzes the positioning relationship, cohesion relationship and the transformation of the relationship between them in the serious illness medical insurance system. Based on the point of view of public policy analysis, this paper comprehensively uses the classical methods of insurance and economics, and expounds the necessity and feasibility of the connection between commercial medical insurance and social medical insurance in the serious illness medical insurance system. The second step of the cohesion study analyzes the background and basic contents of the establishment of the serious illness medical insurance system in China, as well as the current situation of the connection between commercial medical insurance and social medical insurance, with emphasis on the model of Zhanjiang and Taicang. This paper points out the defects existing in the connection process between commercial medical insurance and social medical insurance in the medical insurance system of serious illness under the current situation, and puts forward three key points in the process of connection between the two: the connection between fund raising and payment. The connection of the scope of guarantee and the connection of the object of guarantee. Finally, the paper studies and analyzes the countermeasures of commercial medical insurance and social medical insurance in the medical insurance system of serious illness. Taking Shanghai as an example, this paper designs the scheme of connecting commercial medical insurance with social medical insurance in the medical insurance system of serious illness, and puts forward the internal system guarantee and external incentive conditions needed in the process of connection between the two. Through the study of the connection between commercial medical insurance and social medical insurance, this paper theoretically explains the necessity and feasibility of the connection between commercial medical insurance and social medical insurance in the serious illness medical insurance system, and clarifies the orientation and relationship between the two. This paper gives the concrete connection train of thought and the simple connection model, which provides a kind of train of thought that can be used for reference for the further academic research of the medical insurance system for serious illness, and even for the implementation of the policy of the connection between commercial insurance and social insurance.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：F842.684

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