本文選題：城鎮(zhèn)職工醫(yī)療保險 + 城鄉(xiāng)居民醫(yī)療保險　； 參考：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:我國已基本實現(xiàn)以城鎮(zhèn)職工醫(yī)療保險制度、城鎮(zhèn)居民醫(yī)療保險制度和新型農(nóng)村合作醫(yī)療保險制度為主體的覆蓋全民的基本醫(yī)療保障體系。雖然三種醫(yī)療保險制度的建立和全面實施在一定程度上解決了覆蓋人群狹窄層面上的不公平問題,但由于三種醫(yī)療保險制度的設(shè)計定位、提出背景不同,在多年的獨立運行之后,在籌資水平、補償范圍、補償比例等方面的存在著較大差異,我國醫(yī)療保障體系在一定程度上很難達到真正的公平。因此,在解決了制度從無到有的不公平問題之后,我們應(yīng)當更進一步的關(guān)注各項制度給相應(yīng)人群提供的保障程度是否公平。否則,在"以收定支"的醫(yī)療保險基金籌集原則下,不同的制度差異容易被簡單合理化,給不同制度下參保群體的收益公平性帶來損害[1]。因此,統(tǒng)籌城鄉(xiāng)居民醫(yī)保,保障人人獲得平等的醫(yī)療機會及相符的醫(yī)療待遇是醫(yī)療改革中需要關(guān)注的重點問題。本文將通過對珠海市不同醫(yī)療保險制度的研究,選取合理有效的醫(yī)療保險公平性評價指標和測量方法,探討珠海市不同醫(yī)療保險制度下衛(wèi)生服務(wù)利用公平性程度,為建立健全我國全民醫(yī)療保障體系提供一定的參考。方法:選取珠海市醫(yī)療保險制度作為研究對象。首先,根據(jù)研究對象實施城鄉(xiāng)居民醫(yī)療保險制度的實際情況,結(jié)合專家建議,選取出具有普遍性、代表性的評價指標;其次,通過文獻研究、查找相關(guān)數(shù)據(jù)資料,對珠海市2006年到2015年醫(yī)療保險基金收支進行泰爾指數(shù)分析,并對珠海市、佛山市和肇慶市進行公平性比較;最后,采用比較分析法對所收集的相關(guān)數(shù)據(jù)與資料進行分析研究,并對三市的籌資公平性和醫(yī)療服務(wù)利用公平性進行回歸分析,得出結(jié)果,并對結(jié)果進行深入討論研究。結(jié)果:通過對珠海市基本醫(yī)療保險制度的相關(guān)數(shù)據(jù)研究,得出珠海市基本醫(yī)療保險制度的籌資公平性和醫(yī)療服務(wù)利用公平性的泰爾指數(shù)逐年下降,表明其公平性逐步提高;從珠海市、佛山市和肇慶市的對比來看,佛山市的公平性最高,肇慶市的籌資公平性較好,珠海市的公平性平穩(wěn)發(fā)展。同時,珠海市城鎮(zhèn)職工醫(yī)療保險制度統(tǒng)籌基金結(jié)余情況較高,其累計結(jié)余的可支付水平達22.7個月,包含個人賬戶基金在內(nèi)的職工醫(yī)療保險基金累計結(jié)余率為91.04%,城鄉(xiāng)居民醫(yī)療保險基金結(jié)余情況良好。結(jié)論:首先,城鄉(xiāng)居民醫(yī)療保險制度的待遇水平比較城鎮(zhèn)職工醫(yī)療保險制度有待提高;再者,城鎮(zhèn)職工醫(yī)療保險制度的統(tǒng)籌基金結(jié)余過多,結(jié)余可支付醫(yī)療保險費用幾乎2年,基金池沉積過多,基金沒能到有效利用。針對本文提出的基本醫(yī)療保險制度在社會醫(yī)療保險制度、醫(yī)療保險待遇水平和醫(yī)療保險基金這三方面的不公平提出了對策。提出了相應(yīng)對策,從提高城鄉(xiāng)居民醫(yī)療保險制度待遇、促進珠海市醫(yī)療保險制度一體化和提升基礎(chǔ)醫(yī)療服務(wù)利用公平性來實現(xiàn)珠海市基本醫(yī)療保險制度的保障措施;加強對基本醫(yī)療保險基金的管理來,尤其是關(guān)注城鎮(zhèn)職工醫(yī)療保險統(tǒng)籌基金的相關(guān)運行情況,建立健全基本醫(yī)療保險基金預(yù)警系統(tǒng),加強基本醫(yī)療保險基金收支預(yù)算管理,提高統(tǒng)籌基金利用效率。通過更為有效地措施實施,以期最終實現(xiàn)基本醫(yī)療保險制度的公平性,為我國城鄉(xiāng)醫(yī)療保險制度在"十三五"期間更好的發(fā)展提出了相關(guān)建議。
[Abstract]:Objective: China has basically realized the basic medical security system covering the medical insurance system of urban workers, the medical insurance system of urban residents and the new rural cooperative medical insurance system. Although the establishment and full implementation of the three kinds of medical insurance systems have solved the narrow level of the coverage of the population in a certain range. Fair problem, but because of the three kinds of medical insurance system design positioning, the background is different, after years of independent operation, in the financing level, compensation range, the proportion of compensation, and other aspects of the big difference, our medical security system is difficult to a certain extent to achieve real fairness. After the problem of inequality, we should pay more attention to the fairness of the system provided to the corresponding population. Otherwise, under the principle of collecting the medical insurance fund, different institutional differences are easy to be rationalized, and bring damage to the equity of the insured groups under different systems [1]., therefore, To raise the medical insurance of urban and rural residents, to ensure that everyone gets equal medical opportunities and to meet medical treatment is the key issue in the medical reform. This article will select a reasonable and effective evaluation index and measurement method of the fairness of medical insurance through the study of the different medical insurance system in Zhuhai, and discuss the different medical insurance system in Zhuhai. In order to provide a certain reference for the establishment and improvement of the national medical security system in China, the health care system in China is given a certain reference. Methods: the medical insurance system in Zhuhai is selected as the research object. First, according to the actual situation of the medical insurance system of urban and rural residents, the experts suggest that the medical insurance system is universal and representative. Secondly, through the literature study, searching for relevant data, the Zhuhai city from 2006 to 2015, the balance of the balance of medical insurance funds was analyzed, and the fairness of Zhuhai, Foshan and Zhaoqing was compared. Finally, the comparative analysis method was used to analyze the related data and data of the collected collection and to the three cities. The equity of financing and the use of fairness in medical services are analyzed, and the results are obtained. The results are discussed in depth. Results: through the study of the relevant data of the basic medical insurance system in Zhuhai, it is concluded that the equity of financing in the basic medical insurance system in Zhuhai and the equity index of the fair use of medical services are declining year by year. From the contrast of Zhuhai, Foshan and Zhaoqing, the equity of Foshan is the highest, the equity of Zhaoqing is fairly fair, the equity of Zhaoqing is fair, and the fair development of Zhuhai city is steady. At the same time, the balance of the medical insurance system of the urban workers in Zhuhai is high, and the total surplus can be paid up to 22.7. In the month, the cumulative surplus rate of the medical insurance fund, including the individual account fund, was 91.04%, and the balance of the medical insurance fund of the urban and rural residents was good. More than 2 years, the surplus can pay the medical insurance cost almost 2 years, the fund pool has been too much, the fund has not been able to make effective use. According to the basic medical insurance system proposed in this article in the social medical insurance system, the medical insurance treatment level and the medical insurance fund the three aspects of unfair countermeasures, put forward the corresponding countermeasures, from the improvement of urban and rural areas. The treatment of residents' medical insurance system, promote the integration of medical insurance system in Zhuhai and improve the basic medical service to realize the basic medical insurance system in Zhuhai; strengthen the management of the basic medical insurance fund, especially pay attention to the related operation of the medical insurance fund for urban workers and workers. We should improve the early warning system for the basic medical insurance fund, strengthen the budget management of the basic medical insurance fund and improve the utilization efficiency of the overall fund. Through more effective measures, the fairness of the basic medical insurance system is finally realized, and the related construction is put forward for the better development of the urban and rural medical insurance system during the "13th Five-Year" period. Argumentative.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.1;F842.684

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