發(fā)布時間：2018-03-10 03:07

  本文選題：城鎮(zhèn)職工基本醫(yī)療保險　切入點：費用控制　出處：《華僑大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：隨著社會的不斷發(fā)展和進步,人們的醫(yī)療保健意識不斷增強,各種醫(yī)療保險應(yīng)運而生。醫(yī)療保險是為補償治療疾病所產(chǎn)生費用的一種保險。城鎮(zhèn)職工基本醫(yī)療保險是由用人單位和個人共同繳費建立保險基金,參保人員患病就診產(chǎn)生治療費用后,保險經(jīng)辦機構(gòu)負(fù)責(zé)給予其一定經(jīng)濟補償,以減輕參保人員的經(jīng)濟負(fù)擔(dān)。城鎮(zhèn)職工基本醫(yī)療保險制度是一種補償城鎮(zhèn)職工因治療疾病所產(chǎn)生經(jīng)濟損失的社會醫(yī)療保險制度,是我國社會保障體系的一個重要組成部分,有效降低了參保人員的患病治療的經(jīng)濟壓力,對促進社會主義和諧社會建設(shè)發(fā)揮了積極作用。隨著參保人數(shù)的不斷增多以及人們健康意識在逐漸增強,城鎮(zhèn)職工基本醫(yī)療保險支出費用增速過快的問題凸顯,必須有效采取措施,不斷完善城鎮(zhèn)職工基本醫(yī)療保險相關(guān)制度,控制醫(yī)療保險費用的增速,從而確保我國的這一基本醫(yī)療保險制度的順利發(fā)展。本文將大數(shù)法則、博弈論、道德風(fēng)險理論和控制論等理論引入城鎮(zhèn)職工基本醫(yī)療保險費用的控制研究中,在分析晉江市的城鎮(zhèn)職工基本醫(yī)療保險費用控制現(xiàn)狀后,認(rèn)為晉江市城鎮(zhèn)職工基本醫(yī)療保險費用控制主要存在住院醫(yī)療費用增長過快、藥品費用占醫(yī)療費用比例過大、患者就醫(yī)行為缺乏約束、自付比例設(shè)置不科學(xué)、醫(yī)療保險結(jié)算制度不合理和醫(yī)療保險費用支出監(jiān)測體系不健全等問題。同時,本文通過查閱文獻,分別以世界上最早建立社會保障制度的德國、發(fā)達國家里唯一一個不實行全民醫(yī)療保險的美國和實行國家醫(yī)療保險全面覆蓋的英國等三個西方國家以及上海、鎮(zhèn)江和青島等國內(nèi)典型城市為研究對象,學(xué)習(xí)借鑒國內(nèi)外先進醫(yī)療保險費用控制經(jīng)驗。最后,本文結(jié)合晉江市的實際情況,分別從醫(yī)療服務(wù)供給方(主要針對醫(yī)保定點醫(yī)院)、醫(yī)療服務(wù)需求方(參保患者)、醫(yī)療保險經(jīng)辦機構(gòu)(晉江市醫(yī)保中心)及加強政府職能和作用等四方面提出構(gòu)建適合的醫(yī)療保險費用支付方式、科學(xué)控制支付比例、完善醫(yī)療服務(wù)信息發(fā)布機制等措施,希望可以對控制晉江市醫(yī)療保險費用的增長發(fā)揮作用,并為國內(nèi)其它城市城鎮(zhèn)職工基本醫(yī)療保險費用控制提供參考。
[Abstract]:With the continuous development and progress of the society, people's awareness of medical care has been increasing. Various medical insurance arises at the historic moment. Medical insurance is a kind of insurance to compensate for the expenses caused by the treatment of diseases. The basic medical insurance for urban workers is set up by the joint payment of employers and individuals. The insurance agency shall be responsible for providing certain economic compensation to the insured persons after the medical treatment of the insured person has incurred treatment expenses. The basic medical insurance system for urban workers is a social medical insurance system that compensates for the economic losses caused by the treatment of diseases among urban workers, and is an important part of the social security system of our country. It has effectively reduced the economic pressure of medical treatment for insured personnel and played a positive role in promoting the construction of a harmonious socialist society. With the increasing number of insured persons and the increasing awareness of people's health, The problem of the excessive increase in the expenditure on basic medical insurance for urban workers has been highlighted. It is necessary to take effective measures to continuously improve the relevant system of basic medical insurance for urban workers and to control the growth of medical insurance expenses. In order to ensure the smooth development of the basic medical insurance system in China, this paper introduces the large number theory, game theory, moral hazard theory and cybernetics into the study of the control of the basic medical insurance costs of urban workers. After analyzing the current situation of the cost control of basic medical insurance for urban workers in Jinjiang City, it is concluded that the cost control of basic medical insurance for urban workers in Jinjiang City is mainly due to the excessive growth of hospitalization medical expenses and the excessive proportion of drug expenses to medical expenses. There are some problems such as the lack of restraint of patients' behavior to seek medical treatment, the unscientific setting of out-of-pocket ratio, the unreasonable system of medical insurance settlement and the unsound monitoring system of medical insurance expenses. At the same time, this paper refers to the literature, Respectively, Germany, the first country in the world to establish a social security system, the only developed country in the world, the United States, which does not implement universal medical insurance, and the United Kingdom, which has comprehensive coverage of national medical insurance, and Shanghai, Zhenjiang and Qingdao and other typical domestic cities as the research object, learn from the advanced medical insurance cost control experience at home and abroad. Finally, this paper combined with the actual situation of Jinjiang City, Respectively from four aspects of medical service provider (mainly aimed at the designated hospital of medical insurance, the demand side of medical service (insured patients), medical insurance agency (Jinjiang Medical Insurance Center) and strengthening the functions and functions of the government. Appropriate method of payment of medical insurance expenses, It is hoped that the measures such as scientifically controlling the proportion of payment and perfecting the mechanism of issuing medical service information can play a role in controlling the increase of medical insurance costs in Jinjiang and provide a reference for the control of basic medical insurance costs for urban workers in other cities and towns in China.
【學(xué)位授予單位】：華僑大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1;F842.684

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本文編號：1591472