我國城鄉(xiāng)基本醫(yī)療保險制度整合研究
發(fā)布時間：2018-09-03 11:28
【摘要】：2016年1月國務院發(fā)布《關(guān)于整合城鄉(xiāng)居民基本醫(yī)療保險制度的意見》,將原本就備受爭議的醫(yī)保制度整合問題再次提升為社會熱點問題。計劃經(jīng)濟時期城鄉(xiāng)"分割"的醫(yī)保制度在改革開放后逐漸被城鎮(zhèn)職工基本醫(yī)療保險制度、城鄉(xiāng)居民基本醫(yī)療保險制度和新型農(nóng)村合作制度所取代,城鄉(xiāng)三項基本醫(yī)保制度各自獨立運行,再加上城鄉(xiāng)醫(yī)療救助制度,"三險一助"所構(gòu)成的醫(yī)療保障體系在我國社會保障體系中占據(jù)重要地位。但隨著市場經(jīng)濟體制的改革,"分割"的醫(yī)保制度已經(jīng)無法適應社會發(fā)展要求,重復參保問題凸顯,資源浪費嚴重,醫(yī)保管理效率低下,使得整合"分割"的基本醫(yī)保制度逐漸成為社會共識�？傮w來看,城鄉(xiāng)三項基本醫(yī)保制度的同質(zhì)性決定其制度整合的可能性,制度的差異性決定其制度整合的復雜性。長期的城鄉(xiāng)二元分割背景下,地區(qū)間經(jīng)濟發(fā)展水平差異明顯,導致制度整合無法在全國范圍內(nèi)統(tǒng)一實施,只能選取試點現(xiàn)行的辦法。但各試點地區(qū)采取的整合辦法地方色彩嚴重,沒有形成統(tǒng)一的、具有普適性的整合辦法,使原本就處于"碎片化"的醫(yī)保制度,陷入"再碎片化"悖論。結(jié)合地方試點試驗可以發(fā)現(xiàn),新農(nóng)合和城鎮(zhèn)居民醫(yī)保制度相似度高,可以先整合成為城鄉(xiāng)居民基本醫(yī)保制度,這兩項制度整合的難點在于整合后的行政管理權(quán)歸屬問題;但這兩項基本醫(yī)保制度與職工基本醫(yī)保制度在繳費方式、待遇支付等方面都存在巨大差異,無法直接整合,可以以城鄉(xiāng)居民基本醫(yī)保制度為過渡,逐漸縮小制度差異,為實現(xiàn)"三保合一"做準備。本文先通過梳理城鄉(xiāng)三項基本醫(yī)保制度內(nèi)容,比較城鄉(xiāng)三項基本醫(yī)保制度間存在的異同,尋找制度間的銜接點;其次通過制度"分割"運行所暴露出來的不良效應,得出制度整合的必要性;然后通過分析整合試點的現(xiàn)狀及其存在問題,探究制度難以整合的原因及其影響因素;最后提出整合城鄉(xiāng)三項基本醫(yī)保制度的對策建議,推進醫(yī)保制度整合的順利進行。
[Abstract]:In January 2016, the State Council issued "opinions on integrating the basic medical insurance system for urban and rural residents," raising the controversial issue of health care system integration once again to a social hot issue. After the reform and opening up, the medical insurance system of urban and rural areas was gradually replaced by the basic medical insurance system of urban and rural residents and the new rural cooperative system. The three basic medical insurance systems in urban and rural areas operate independently, and in addition to the medical assistance system in urban and rural areas, the medical security system composed of "three risks and one aid" occupies an important position in the social security system of our country. However, with the reform of the market economy system, the "split" medical insurance system has been unable to meet the needs of social development. The problem of repeated participation in insurance has become prominent, the waste of resources is serious, and the efficiency of medical insurance management is low. So that the integration of the "division" of the basic health care system has gradually become a social consensus. In general, the homogeneity of the three basic medical insurance systems in urban and rural areas determines the possibility of institutional integration, and institutional differences determine the complexity of institutional integration. Under the background of urban-rural dual division for a long time, the difference of economic development level between regions is obvious, which leads to the system integration can not be implemented uniformly in the whole country, so it can only select the current method of pilot project. However, the integration method adopted in each pilot area is serious in local color and has not formed a unified and universal integration method, which makes the medical insurance system already in "fragmentation" and falls into the paradox of "refragmentation". Combined with the local pilot test, it can be found that the new rural cooperative and urban residents medical insurance system has high similarity, and can be integrated into the basic medical insurance system of urban and rural residents first. The difficulty of the integration of these two systems lies in the ownership of administrative management rights after integration; However, these two basic medical insurance systems and the basic medical insurance system for employees have huge differences in the way of payment, payment of benefits, and so on, which cannot be directly integrated. We can take the basic medical insurance system of urban and rural residents as the transition and gradually narrow the differences in the system. Prepare for the realization of "three guarantees in one". This paper first combs the contents of the three basic medical insurance systems in urban and rural areas, compares the similarities and differences between the three basic medical insurance systems in urban and rural areas, and looks for the convergence points between the systems. Then through the analysis of the status quo and existing problems of the integration of the pilot, explore the reasons for the difficult integration of the system and its impact factors; finally, put forward the integration of urban and rural three basic health insurance system countermeasures and suggestions, To promote the smooth integration of the medical insurance system.
【學位授予單位】：山西大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R197.1;F842.684
本文編號：2219850
[Abstract]:In January 2016, the State Council issued "opinions on integrating the basic medical insurance system for urban and rural residents," raising the controversial issue of health care system integration once again to a social hot issue. After the reform and opening up, the medical insurance system of urban and rural areas was gradually replaced by the basic medical insurance system of urban and rural residents and the new rural cooperative system. The three basic medical insurance systems in urban and rural areas operate independently, and in addition to the medical assistance system in urban and rural areas, the medical security system composed of "three risks and one aid" occupies an important position in the social security system of our country. However, with the reform of the market economy system, the "split" medical insurance system has been unable to meet the needs of social development. The problem of repeated participation in insurance has become prominent, the waste of resources is serious, and the efficiency of medical insurance management is low. So that the integration of the "division" of the basic health care system has gradually become a social consensus. In general, the homogeneity of the three basic medical insurance systems in urban and rural areas determines the possibility of institutional integration, and institutional differences determine the complexity of institutional integration. Under the background of urban-rural dual division for a long time, the difference of economic development level between regions is obvious, which leads to the system integration can not be implemented uniformly in the whole country, so it can only select the current method of pilot project. However, the integration method adopted in each pilot area is serious in local color and has not formed a unified and universal integration method, which makes the medical insurance system already in "fragmentation" and falls into the paradox of "refragmentation". Combined with the local pilot test, it can be found that the new rural cooperative and urban residents medical insurance system has high similarity, and can be integrated into the basic medical insurance system of urban and rural residents first. The difficulty of the integration of these two systems lies in the ownership of administrative management rights after integration; However, these two basic medical insurance systems and the basic medical insurance system for employees have huge differences in the way of payment, payment of benefits, and so on, which cannot be directly integrated. We can take the basic medical insurance system of urban and rural residents as the transition and gradually narrow the differences in the system. Prepare for the realization of "three guarantees in one". This paper first combs the contents of the three basic medical insurance systems in urban and rural areas, compares the similarities and differences between the three basic medical insurance systems in urban and rural areas, and looks for the convergence points between the systems. Then through the analysis of the status quo and existing problems of the integration of the pilot, explore the reasons for the difficult integration of the system and its impact factors; finally, put forward the integration of urban and rural three basic health insurance system countermeasures and suggestions, To promote the smooth integration of the medical insurance system.
【學位授予單位】：山西大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R197.1;F842.684
【參考文獻】
相關(guān)期刊論文 前10條
1 郭寶安;王世開;江英;;發(fā)揮社保經(jīng)辦機構(gòu)的管理優(yōu)勢在城鄉(xiāng)醫(yī)保整合中彰顯作為——基于山東省沂水縣的實踐[J];中國醫(yī)療保險;2016年02期
2 申夏麗;;有效利用職工醫(yī)保個人賬戶基金[J];經(jīng)濟師;2015年12期
3 孫淑云;;頂層設(shè)計城鄉(xiāng)醫(yī)保制度:自上而下有效實施整合[J];中國農(nóng)村觀察;2015年03期
4 趙冬梅;;城鄉(xiāng)基本醫(yī)療保險一體化發(fā)展現(xiàn)狀及問題研究[J];吉林工商學院學報;2015年02期
5 任志強;;提升醫(yī)保統(tǒng)籌層次路在何方[J];中國社會保障;2015年03期
6 田珍都;;當前城鄉(xiāng)居民醫(yī)保整合工作存在問題及對策[J];行政管理改革;2015年02期
7 程毅;;城鎮(zhèn)化進程中的新型農(nóng)村合作醫(yī)療制度可持續(xù)發(fā)展研究[J];福建論壇(人文社會科學版);2015年02期
8 李珍;趙青;;制度變遷視角下的城鎮(zhèn)職工基本醫(yī)療保險公平性評估[J];北京社會科學;2014年07期
9 顧海;;中國統(tǒng)籌城鄉(xiāng)醫(yī)療保障制度模式與路徑選擇[J];學海;2014年01期
10 孫淑云;;“新型農(nóng)村合作醫(yī)療管理條例”制定的戰(zhàn)略取向——基于城鄉(xiāng)一體化發(fā)展的視角[J];山西大學學報(哲學社會科學版);2014年01期
相關(guān)重要報紙文章 前4條
1 王秀萍;;讓市民盡享大病醫(yī)�！凹t包”[N];山西經(jīng)濟日報;2015年
2 王秀萍;;太原2016年城鎮(zhèn)居民醫(yī)保參保開始繳費[N];山西經(jīng)濟日報;2015年
3 周婷玉;徐博;王海鷹;徐揚;;醫(yī)�？缡〗Y(jié)算還需跨越“三道檻”[N];中華工商時報;2014年
4 李曉并;;2012,“醫(yī)保新政”惠及百姓[N];太原日報;2012年
，本文編號：2219850
本文鏈接：http://sikaile.net/shekelunwen/shehuibaozhanglunwen/2219850.html
最近更新
教材專著
