本文選題：老齡化 + 醫(yī)療保險��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：隨著我國老年人口比重不斷攀升,人口老齡化問題日益凸顯,中老年人這一特殊群體對醫(yī)療服務(wù)的需求和要求較高,是醫(yī)療保險和醫(yī)療保障服務(wù)的重點對象。我國從20世紀(jì)中后期開始建立基本醫(yī)療保險制度,近年來對醫(yī)療保險制度的改革和創(chuàng)新更是力度空前。但是,由于社會、經(jīng)濟(jì)和歷史等多方面的原因,我國的醫(yī)療保險制度仍存在很多問題,在人口老齡化背景下,研究我國醫(yī)療保險制度對中老年人醫(yī)療經(jīng)濟(jì)負(fù)擔(dān)的影響具有深遠(yuǎn)的現(xiàn)實意義。本文在對以往文獻(xiàn)進(jìn)行梳理評述之后,首先介紹了目前我國的老齡化問題和中老年人健康的現(xiàn)狀,并對醫(yī)療保險發(fā)展的情況進(jìn)行分析,同時結(jié)合相關(guān)經(jīng)濟(jì)學(xué)理論和醫(yī)療保險理論闡述本文研究的理論基礎(chǔ)。其次,基于醫(yī)療負(fù)擔(dān)的測算方法,選取宏觀成本法和人力資本法分別測算直接醫(yī)療費用和間接醫(yī)療費用,并確定醫(yī)療經(jīng)濟(jì)負(fù)擔(dān)的其他相關(guān)指標(biāo),分地區(qū)、年齡和醫(yī)療保險類型對醫(yī)療負(fù)擔(dān)進(jìn)行初步評價。然后選取CHARLS2013年的全國基線調(diào)查數(shù)據(jù),采用適當(dāng)?shù)膶嵶C模型控制內(nèi)生性和樣本選擇偏誤問題,衡量不同醫(yī)療保險制度對各類醫(yī)療經(jīng)濟(jì)負(fù)擔(dān)指標(biāo)的影響,并區(qū)別門診與住院形式的不同,比較年齡分組和城鄉(xiāng)差異。最后,為了進(jìn)一步研究大額醫(yī)療費用帶來的因病致貧、返貧問題,結(jié)合城鄉(xiāng)居民大病保險的實施,利用2013年的數(shù)據(jù)進(jìn)行預(yù)測,衡量基本醫(yī)療保險和城鄉(xiāng)居民大病保險對災(zāi)難性衛(wèi)生支出的作用。通過實證分析可以看出:醫(yī)療保險對住院費用的作用比門診費用更顯著,其中城鎮(zhèn)職工醫(yī)療保險顯著促進(jìn)了門診和住院費用的增加且增加幅度最大;城市居民得益于優(yōu)越的醫(yī)療資源和經(jīng)濟(jì)條件,其醫(yī)療費用支出遠(yuǎn)大于農(nóng)村,不同年齡段的醫(yī)療費用支出也有顯著不同;各類基本醫(yī)療保險顯著降低了醫(yī)療費用的自負(fù)比例,但是對于降低醫(yī)療自負(fù)負(fù)擔(dān)的作用較弱;城鄉(xiāng)居民大病保險在基本醫(yī)療保險補(bǔ)償基礎(chǔ)上進(jìn)行的二次報銷可以進(jìn)一步降低災(zāi)難性衛(wèi)生支出的發(fā)生率,減少平均差距和相對差距,但是不同收入群體的作用效果有所差異,對低收入群體的效果有待加強(qiáng),未來隨著大病保險的進(jìn)一步發(fā)展,其對災(zāi)難性衛(wèi)生支出的作用會進(jìn)一步提高。本文在完善醫(yī)療負(fù)擔(dān)測評指標(biāo)的基礎(chǔ)上,更加全面的分析了醫(yī)療保險制度對醫(yī)療經(jīng)濟(jì)負(fù)擔(dān)的作用,并對不同醫(yī)療保險制度類型進(jìn)行對比,區(qū)別就醫(yī)形式、年齡段與城鄉(xiāng)。同時,對大病保險的實施情況進(jìn)行預(yù)測,進(jìn)一步分析了醫(yī)療保險對災(zāi)難性衛(wèi)生支出的作用效果,為今后政策實施的偏重點與改革重點提供了借鑒。
[Abstract]:With the increasing proportion of the elderly population in our country, the problem of aging population is becoming increasingly prominent. The special group of middle-aged and elderly people have a high demand for medical services, which is the key object of medical insurance and medical security services. The basic medical insurance system has been established in China since the middle and late 20th century. In recent years, the reform and innovation of the medical insurance system is unprecedented. However, due to social, economic and historical reasons, there are still many problems in China's medical insurance system. It is of great practical significance to study the effect of medical insurance system on the financial burden of medical care. After combing and commenting on the previous literatures, this paper first introduces the aging problem and the current situation of the health of the middle-aged and the elderly in China, and analyzes the development of medical insurance. At the same time, combined with the relevant economic theory and medical insurance theory to elaborate the theoretical basis of this study. Secondly, based on the calculation method of medical burden, we select macro cost method and human capital method to calculate direct medical cost and indirect medical cost respectively, and determine other related indicators of medical economic burden. Age and type of medical insurance were used to evaluate the medical burden. Then select the national baseline survey data of CHARLS2013 year, adopt appropriate empirical model to control endogenous and sample selection bias, and measure the impact of different medical insurance systems on various indicators of medical financial burden. And the difference between outpatient and hospitalization, age groups and urban and rural differences. Finally, in order to further study the problem of poverty caused by illness and return to poverty caused by large medical expenses, combined with the implementation of urban and rural residents' serious illness insurance, the 2013 data are used to forecast, Measure the effect of basic medical insurance and urban and rural residents' serious illness insurance on catastrophic health expenditure. Through the empirical analysis, we can see that the effect of medical insurance on the inpatient expenses is more significant than that on the outpatient expenses, among which, the urban workers' medical insurance significantly promotes the increase of outpatient and inpatient expenses and the biggest increase; Urban residents benefit from superior medical resources and economic conditions, their medical expenses are far larger than those in rural areas, and the expenditure on medical expenses varies significantly among different age groups; all kinds of basic medical insurance have significantly reduced the proportion of medical expenses borne by themselves. But it has a weak effect on reducing the burden of medical conceit. The secondary reimbursement based on the basic medical insurance can further reduce the incidence of catastrophic health expenditure and reduce the average gap and the relative gap between urban and rural residents. However, the effects of different income groups are different, and the effects on low-income groups need to be strengthened. In the future, with the further development of serious illness insurance, its effect on catastrophic health expenditure will be further improved. On the basis of perfecting the evaluation index of medical burden, this paper analyzes the effect of medical insurance system on medical economic burden, and compares the different types of medical insurance system to distinguish the form of medical treatment, age group and urban and rural areas. At the same time, the implementation of the serious illness insurance is forecasted, and the effect of the medical insurance on the catastrophic health expenditure is further analyzed, which provides a reference for the emphasis of the policy implementation and the reform emphasis in the future.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：D669.6;F842.684

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 高浩榮;韓國醫(yī)療保險財政瀕臨破產(chǎn)[J];w攣胖蕓，

本文編號：1866745