本文選題：長三角 + 農(nóng)村醫(yī)療保險��； 參考：《上海工程技術(shù)大學(xué)》2012年碩士論文

【摘要】：改革開放30年，特別是“十一五”期間，長三角地區(qū)醫(yī)療保險制度建設(shè)成績斐然，覆蓋城鄉(xiāng)居民的醫(yī)療保障體系基本建立，但醫(yī)療保險制度城鄉(xiāng)分割、醫(yī)療保險政策城鄉(xiāng)不一、醫(yī)療保險待遇水平城鄉(xiāng)懸殊等問題突出，在當(dāng)今國家力行基本醫(yī)療保險制度城鄉(xiāng)統(tǒng)籌發(fā)展的背景下,如何解決上述問題，實(shí)現(xiàn)醫(yī)療保險制度從“覆蓋城鄉(xiāng)”到“城鄉(xiāng)一體化”的歷史性跨越，建立城鄉(xiāng)一體化的醫(yī)療保險制度,成為一個值得研究的課題。 論文在醫(yī)療保險制度城鄉(xiāng)一體化發(fā)展理論的指導(dǎo)下，詳述長三角地區(qū)基本醫(yī)療保險的現(xiàn)狀及實(shí)現(xiàn)條件,結(jié)合國內(nèi)外社會醫(yī)療保險城鄉(xiāng)一體化的經(jīng)驗(yàn)?zāi)Ｊ�，試探性的提出在�?jīng)濟(jì)發(fā)展水平相對較高的長三角地區(qū)突破農(nóng)村醫(yī)療保險制度的發(fā)展瓶頸，先行建立城鄉(xiāng)一體化的醫(yī)療保險制度。設(shè)計(jì)了四大實(shí)現(xiàn)方案：方案一,參保對象為所有城鄉(xiāng)居民，籌資繳費(fèi)上個人承擔(dān)30%，，國家承擔(dān)70%，補(bǔ)償比例為門診30%+住院50%。其他方案均在上一方案的基礎(chǔ)上補(bǔ)償比例依次提高10%。運(yùn)用Spss軟件從籌資和供給平衡的角度論證方案的可行性，主要測定人均籌資30%這一繳費(fèi)額度是否在居民上年度收入的2%-3%這一承受繳費(fèi)范圍之內(nèi)。70%的人均籌資額是否在政府財(cái)政支出的5%-7%范圍之內(nèi)。結(jié)果表明方案一、方案二在長三角地區(qū)目前是現(xiàn)實(shí)可行的，隨著經(jīng)濟(jì)發(fā)展方案三、方案四也將逐步實(shí)現(xiàn)。 城鄉(xiāng)一體化的醫(yī)療保險制度設(shè)計(jì)意義重大：一方面，城鄉(xiāng)一體化的醫(yī)療保險制度在政策設(shè)計(jì)上實(shí)現(xiàn)了城鄉(xiāng)的連接貫通，在制度架構(gòu)上實(shí)現(xiàn)了城鄉(xiāng)統(tǒng)籌，在管理服務(wù)上實(shí)現(xiàn)城鄉(xiāng)統(tǒng)一，在待遇標(biāo)準(zhǔn)上實(shí)現(xiàn)城鄉(xiāng)基本一致，順應(yīng)了城鄉(xiāng)經(jīng)濟(jì)社會一體化發(fā)展的大趨勢。另一方面，城鄉(xiāng)一體化的醫(yī)療保險制度有效規(guī)避了城鄉(xiāng)醫(yī)療保險制度各自難以克服的缺陷，最大限度的實(shí)現(xiàn)了醫(yī)療保險制度的公平性，提高了制度運(yùn)行的效率和互助共濟(jì)能力，符合醫(yī)療保險制度自身發(fā)展的規(guī)律。
[Abstract]:During the 30 years of reform and opening up, especially during the "Eleventh Five-Year Plan" period, the construction of the medical insurance system in the Yangtze River Delta region has made great achievements, and the medical security system covering urban and rural residents has basically been established, but the medical insurance system is divided between urban and rural areas, and the medical insurance policy varies from city to country. The gap between urban and rural areas in the level of medical insurance benefits is outstanding. How to solve the above problems in the context of the overall development of the basic medical insurance system in urban and rural areas in the country today? To realize the historic leap of the medical insurance system from "covering urban and rural areas" to "urban-rural integration", and to establish a medical insurance system of urban-rural integration, Under the guidance of the development theory of urban and rural integration of medical insurance system, this paper describes the status quo and realization conditions of basic medical insurance in the Yangtze River Delta region. Combined with the experience of the integration of social medical insurance between urban and rural areas at home and abroad, this paper tentatively proposes to break through the bottleneck of the development of rural medical insurance system in the relatively high level of economic development of the Yangtze River Delta region. First, the establishment of urban and rural integration of medical insurance system. This paper designs four realization schemes: scheme 1, participating in insurance for all urban and rural residents, raising funds and paying fees for the individual to bear 30 points, the state bears 70%, and the proportion of compensation is 30% of the outpatients in hospital. The other schemes are on the basis of the previous program compensation ratio in turn increased by 10. Using SPSS software to prove the feasibility of the scheme from the point of view of financing and supply balance. It is mainly determined whether the payment amount of 30 percent per capita financing is within the range of 2.-3 percent of the residents' income last year, that is, .70 percent of the per capita amount of capital raised within the range of withstanding payment, whether it is within the range of 5-7 percent of the government's fiscal expenditure. The results show that the first and second schemes are realistic and feasible in the Yangtze River Delta region at present. With the economic development plan three, the fourth scheme will be gradually realized. The design of the urban-rural integrated medical insurance system is of great significance: on the one hand, The urban-rural integration of the medical insurance system in terms of policy design to achieve the link between urban and rural areas, in the framework of the system to achieve urban-rural integration, in the management of services to achieve urban-rural unity, in the standard of treatment of urban and rural basically consistent. In line with the development of urban and rural economic and social integration of the general trend. On the other hand, the urban-rural integrated medical insurance system effectively avoids the shortcomings of the urban and rural medical insurance system, realizes the fairness of the medical insurance system to the maximum extent, and improves the efficiency of the system operation and the ability of mutual aid. Accord with the law that medical treatment insurance system oneself develops.
【學(xué)位授予單位】：上海工程技術(shù)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：C913.7

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