本文選題：城鄉(xiāng)居民大病保險(xiǎn) + 信息傳遞�。� 參考：《河北大學(xué)》2017年碩士論文

【摘要】：城鄉(xiāng)居民大病保險(xiǎn)是社保與商業(yè)保險(xiǎn)經(jīng)營(yíng)的結(jié)合,完善的城鄉(xiāng)居民大病保險(xiǎn)體系需要依靠健全的制度基礎(chǔ)、科學(xué)的管理方法、先進(jìn)的操作技術(shù)、嚴(yán)厲的懲戒措施,以及充足的資金。城鄉(xiāng)居民大病保險(xiǎn)不僅需要實(shí)現(xiàn)優(yōu)化結(jié)算方式,制約道德風(fēng)險(xiǎn),還應(yīng)發(fā)展事前預(yù)防保健,嚴(yán)格事中監(jiān)管控制,提升事后高效賠付,完善服務(wù)體系。本文通過(guò)實(shí)地調(diào)研所獲取數(shù)據(jù),分析河北省城鄉(xiāng)居民大病保險(xiǎn)的發(fā)展歷程、補(bǔ)償水平、經(jīng)營(yíng)水平,發(fā)現(xiàn)河北省城鄉(xiāng)居民大病保險(xiǎn)發(fā)展中存在道德風(fēng)險(xiǎn)頻發(fā)、醫(yī)保信息不對(duì)稱(chēng)、政策性風(fēng)險(xiǎn)及基金持續(xù)性等方面問(wèn)題,分析得知這些問(wèn)題的產(chǎn)生是由于城鄉(xiāng)居民大病保險(xiǎn)參與方的合作方式不當(dāng)。在此基礎(chǔ)上,分析城鄉(xiāng)居民大病保險(xiǎn)主要參與方間的合作關(guān)系及影響各自決策的因素,發(fā)現(xiàn)管理成本會(huì)影響城鄉(xiāng)居民大病保險(xiǎn)業(yè)務(wù)質(zhì)量和經(jīng)營(yíng),政府支持力度和適當(dāng)?shù)慕?jīng)濟(jì)獎(jiǎng)懲措施會(huì)影響城鄉(xiāng)居民大病保險(xiǎn)參與方的決策,這點(diǎn)在國(guó)內(nèi)外先進(jìn)城鄉(xiāng)居民大病保險(xiǎn)經(jīng)營(yíng)模式中也有所體現(xiàn)。最后總結(jié)先進(jìn)城鄉(xiāng)居民大病保險(xiǎn)模式特點(diǎn),并結(jié)合河北省城鄉(xiāng)居民大病保險(xiǎn)發(fā)展中的突出問(wèn)題給出可行性建議,認(rèn)為城鄉(xiāng)居民大病保險(xiǎn)業(yè)務(wù)前期應(yīng)制定明確的招標(biāo)標(biāo)準(zhǔn)、風(fēng)險(xiǎn)共擔(dān)機(jī)制,在各機(jī)構(gòu)之間建立通暢且完備的信息交流平臺(tái),實(shí)現(xiàn)信息的有效傳遞;中期加強(qiáng)醫(yī)療巡查,制約道德風(fēng)險(xiǎn);在后期提供快速、及時(shí)的醫(yī)療賠付,并對(duì)業(yè)務(wù)發(fā)展做出準(zhǔn)確評(píng)價(jià),制定激勵(lì)獎(jiǎng)懲措施,以促進(jìn)河北省城鄉(xiāng)居民大病保險(xiǎn)的健康持續(xù)發(fā)展。
[Abstract]:The serious illness insurance of urban and rural residents is a combination of social security and commercial insurance. A sound insurance system for urban and rural residents needs to rely on sound institutional basis, scientific management methods, advanced operational techniques, and severe disciplinary measures. And adequate funding. The urban and rural residents' serious illness insurance not only needs to optimize the settlement method, restrict the moral hazard, but also should develop the preventive health care beforehand, strictly supervise and control in the matter, promote the effective compensation after the event, perfect the service system. This paper analyzes the development process, compensation level and management level of the serious illness insurance of urban and rural residents in Hebei Province through the data obtained from field investigation. It is found that there are frequent moral risks and asymmetric medical insurance information in the development of the insurance for urban and rural residents in Hebei Province. Based on the analysis of policy risk and fund sustainability, it is found that these problems are due to the improper cooperation between urban and rural residents. On this basis, the paper analyzes the cooperative relationship between the main participants and the factors that affect their decision-making, and finds that the management cost will affect the quality and management of the insurance business of urban and rural residents. The government support strength and appropriate economic rewards and punishments will affect the decision of the participants of the urban and rural residents' serious illness insurance, which is also reflected in the advanced management mode of the urban and rural residents' serious illness insurance at home and abroad. Finally, this paper summarizes the characteristics of advanced urban and rural residents' serious illness insurance model, and puts forward some feasible suggestions in combination with the prominent problems in the development of Hebei Province's urban and rural residents' serious illness insurance, and thinks that the early stage of urban and rural residents' serious illness insurance business should formulate a clear bidding standard. Risk sharing mechanism to establish a smooth and complete information exchange platform among institutions to realize the effective transmission of information; to strengthen medical inspection in the medium term, to restrict moral hazard; to provide rapid and timely medical compensation in the later period, In order to promote the healthy and sustainable development of urban and rural residents insurance in Hebei Province, the author makes an accurate evaluation of the business development, and formulates incentives, rewards and punishment measures.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：F842.684

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