【摘要】：醫(yī)療保險制度是指某個國家依照保險合同規(guī)定,為解決國民預(yù)防治療疾病問題而籌措、分配并使用醫(yī)療保險基金的制度。醫(yī)療保險制度是一種比較進(jìn)步的社會保障制度,是人類文明進(jìn)步與社會積極發(fā)展的必然結(jié)果,對于維持社會安定、確保社會經(jīng)濟(jì)的健康可持續(xù)發(fā)展有著不可替代的作用。同時,醫(yī)療保險制度的改革一直是中國醫(yī)藥衛(wèi)生體制改革的重要部分,更是“三醫(yī)聯(lián)動”所不可或缺的一環(huán),其未來的改革與發(fā)展方向關(guān)系到“新醫(yī)改”的成敗與否。日本不僅是亞洲第一個實(shí)行醫(yī)療保險的國家,而且是世界范圍內(nèi)建立醫(yī)療保險制度較早的國家之一。其醫(yī)療保險制度的管理模式早期由德國引進(jìn),在第二次世界大戰(zhàn)之后又借鑒了美國的一些做法,逐漸制訂實(shí)施了一系列的衛(wèi)生立法及相關(guān)的法律法規(guī),最終形成了獨(dú)具日本特色的醫(yī)療保險制度。這一制度的建立對于維護(hù)日本經(jīng)濟(jì)的持續(xù)、穩(wěn)定發(fā)展以及保障日本社會的安定、有序運(yùn)行發(fā)揮了舉足輕重的作用。當(dāng)下,中國醫(yī)改進(jìn)入深水區(qū),醫(yī)療保險制度的改革同樣面臨著諸多挑戰(zhàn)。而日本醫(yī)療保險制度在發(fā)展的過程中,曾經(jīng)遇到的或正在積極應(yīng)對的很多難題與中國的問題具有相似性,而且很多的改革措施已經(jīng)取得了顯著成效。同時,日本與中國同屬儒家文化圈,都是具有悠久農(nóng)業(yè)社會歷史的國家,兩者在文化淵源與經(jīng)濟(jì)社會演化路徑上具有相通性和相似性。因此,這就使得借鑒日本醫(yī)療保險制度的改革相關(guān)方法與措施,促進(jìn)中國醫(yī)療保險制度的發(fā)展進(jìn)步成為可能。本文通過醫(yī)療保險制度的經(jīng)濟(jì)效應(yīng)作為研究重點(diǎn),在橫向比較歷史沿革和縱向?qū)Ρ染唧w項(xiàng)目的基礎(chǔ)上,采用“推拉效應(yīng)”模型和醫(yī)療保險制度居民消費(fèi)效應(yīng)模型對中日醫(yī)療保險制度的經(jīng)濟(jì)效應(yīng)進(jìn)行實(shí)證分析。在其基礎(chǔ)上得出結(jié)論并嘗試對中國醫(yī)療保險制度的改革與完善提出政策建議。本文除緒論外,主要分為五章,具體內(nèi)容安排如下：第一章介紹了相關(guān)概念的界定及相關(guān)基礎(chǔ)理論。本章節(jié)著重對研究中需要使用的幾個重要概念進(jìn)行了具體界定,同時對公共產(chǎn)品及市場失靈理論、逆向選擇與道德風(fēng)險和消費(fèi)理論等相關(guān)基礎(chǔ)理論進(jìn)行論述。第二章通過發(fā)展歷程的角度對中日醫(yī)療保險制度進(jìn)行縱向比較。本章節(jié)從歷史沿革、運(yùn)行現(xiàn)狀和演化路徑三個角度,從縱向上對中日醫(yī)療保險制度進(jìn)行比較,在概述兩國醫(yī)保制度發(fā)展進(jìn)程的基礎(chǔ)上,勾勒出各自醫(yī)療保險制度的整體框架結(jié)構(gòu),最后從制度演化路徑的差異上發(fā)現(xiàn)中國的不足與日本的優(yōu)勢。第三章通過具體項(xiàng)目的角度對中日醫(yī)療保險制度進(jìn)行橫向比較。本章節(jié)為進(jìn)一步對中日兩國現(xiàn)行醫(yī)保制度進(jìn)行對比分析,特選取保險人、參保對象、籌資制度、支付制度和收支情況五個具體項(xiàng)目,通過不同項(xiàng)目指標(biāo)和考察角度來對中日醫(yī)療保險制度進(jìn)行橫向上的比較研究�；谙嗤�(xiàng)目上的異同,發(fā)現(xiàn)和借鑒日本的特色與創(chuàng)新點(diǎn),以改進(jìn)中國的問題與不足。第四章這是本文的核心章節(jié),即中日醫(yī)療保險制度經(jīng)濟(jì)效應(yīng)的實(shí)證分析�？紤]到作者本人的現(xiàn)實(shí)能力,本文的研究將主要專注于宏觀層面的研究分析。在這里,為了便于進(jìn)行研究和計算,本文將醫(yī)療保險制度的經(jīng)濟(jì)效應(yīng)分為兩個部分,即國民經(jīng)濟(jì)層面上的經(jīng)濟(jì)發(fā)展效應(yīng)和居民個體層面上的居民消費(fèi)效應(yīng)。對于經(jīng)濟(jì)發(fā)展效應(yīng)的研究分析,本文將采用“推拉效應(yīng)”模型進(jìn)行具體測算,具體指標(biāo)主要包括：人均GDP和醫(yī)療保險基金支出,來考察醫(yī)療保險制度對于國民經(jīng)濟(jì)發(fā)展的影響。而對于居民消費(fèi)效應(yīng)的研究分析,本文將通過構(gòu)建醫(yī)療保險制度模型來進(jìn)行具體測算,具體指標(biāo)主要包括：本國居民消費(fèi)水平、本國醫(yī)療保險人均支出、本國居民的人均財富量和本國撫養(yǎng)比,來考察醫(yī)療保險制度對于居民消費(fèi)水平的影響。通過在相關(guān)文獻(xiàn)和官方網(wǎng)站上的公開數(shù)據(jù),進(jìn)行中日醫(yī)療保險制度經(jīng)濟(jì)效應(yīng)的計算比較,并對中日兩國的分析結(jié)果進(jìn)行簡要說明。第五章提出結(jié)論和相關(guān)建議。針對存在問題,根據(jù)測算數(shù)據(jù),提出改革醫(yī)療保險支付制度、促進(jìn)衛(wèi)生資源合理配置、多種方式破除“以藥養(yǎng)醫(yī)”、激發(fā)調(diào)動醫(yī)務(wù)人員積極性和加快完善配套制度改革等具體建議。
[Abstract]:Medical insurance system refers to a system in which a country raises funds for the prevention and treatment of diseases and distributes and uses medical insurance funds in accordance with the provisions of insurance contracts. At the same time, the reform of the medical insurance system has always been an important part of the reform of China's medical and health system, and also an indispensable part of the "three medical links". The future reform and development direction of the medical insurance system is related to the success or failure of the "new medical reform". Japan is not only Asia. It was the first country in the continent to implement medical insurance and one of the earliest countries in the world to establish a medical insurance system. The management model of its medical insurance system was introduced from Germany in the early days. After World War II, it drew lessons from some practices in the United States and gradually formulated and implemented a series of health legislation and related laws. The establishment of this system has played an important role in maintaining the sustained development of the Japanese economy, ensuring the stability and orderly operation of the Japanese society. In the course of the development of this medical insurance system, many problems that have been encountered or are being actively dealt with are similar to those in China, and many reform measures have achieved remarkable results. There are similarities and similarities in the path of economic and social evolution. Therefore, it is possible to learn from the relevant methods and measures of the reform of Japanese medical insurance system to promote the development and progress of China's medical insurance system. On the basis of specific items, this paper uses the "push-pull effect" model and the consumption effect model of medical insurance system to analyze the economic effects of Chinese and Japanese medical insurance system. The specific contents are as follows: Chapter 1 introduces the definition of relevant concepts and related basic theories. This chapter focuses on the specific definition of several important concepts to be used in the study. At the same time, it discusses the basic theories of public goods and market failure theory, adverse selection and moral hazard and consumption theory. This chapter compares the medical insurance system of China and Japan from three angles: historical evolution, operation status and evolution path, compares the medical insurance system of China and Japan vertically, and outlines the overall framework of the medical insurance system of the two countries on the basis of summarizing the development process of the medical insurance system. In the third chapter, the author compares the Chinese and Japanese medical insurance systems horizontally from the perspective of specific projects. This chapter makes a further comparative analysis of the current medical insurance systems in China and Japan, especially selects the insurers, the insured, the financing system, the payment system and the acceptance system. Based on the similarities and differences of the same items, we find and learn from the characteristics and innovations of Japan in order to improve China's problems and deficiencies. Chapter 4 is the core chapter of this paper, namely, the Sino-Japanese medical insurance system. Considering the author's practical ability, this paper will mainly focus on the macro-level research and analysis. Here, in order to facilitate research and calculation, this paper divides the economic effect of the medical insurance system into two parts, namely, the economic development effect on the national economic level and the residents'individual level. For the research and analysis of the economic development effect, this paper will use the "push-pull effect" model to calculate the specific indicators, including: per capita GDP and medical insurance fund expenditure, to examine the impact of the medical insurance system on the national economic development. This paper will build a model of medical insurance system to calculate the specific indicators, including: the level of domestic consumption, the per capita expenditure on medical insurance, the per capita wealth of domestic residents and the domestic dependency ratio, to examine the impact of the medical insurance system on the level of consumption of residents. The fifth chapter puts forward the conclusion and relevant suggestions. Aiming at the existing problems, according to the calculation data, the paper proposes to reform the medical insurance payment system, promote the rational allocation of health resources, and break the "medicine for medical care" in many ways. "To stimulate the enthusiasm of mobilizing medical personnel and accelerate the improvement of supporting system reform.
【學(xué)位授予單位】：遼寧大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：F842.684;R197.1

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