南通市全民医保制度运行中的问题与对策分析

发布时间：2018-09-12 18:45

【摘要】：长久以来,病有所医一直是我国老百姓的梦想。传统的城镇职工劳动保障制度、公费医疗制度、农村合作医疗制度的保障能力已经跟不上经济社会发展的需要,“看病难、看病贵”已经成为老百姓就医中最为突出的问题。从国内外发展的经验来看,要解决此问题,唯有发展全民医保制度。作为国务院确定的第二批医疗保险制度改革试点城市,南通市从1997年进行医疗保障体制改革以来,经过十余年的努力,已建立了一个覆盖全市城乡百姓的基本医疗保障制度,从制度的覆盖范围来看,南通市已迈入了全民医保时代。但制度的全覆盖仅是实践全民医保之路的第一步,南通市目前正在着手提高群众的医疗保障水平,使全民医保从制度的全覆盖上升到保障水平和保障能力的全覆盖。在人人均享有医疗保障的南通市,医保制度的设计关系到全市百万参保群众的切身利益。南通市在全民医保制度的实践中,不可能完全照搬国内外的现成模式,因此南通市在发展符合当地实情的全民医保之路上不可能平坦,必将面临各种挑战,也不可避免的产生一些问题。本文从南通医疗保障制度亲历者和实践者的角度,运用公共管理的理论知识,采用文献研究、比较分析、实地调查、分析归纳等研究方法,系统总结、分析南通市全民医保制度的发展历程和发展现状,深入挖掘制度运行中所存在的问题,并对这些问题成因进行分析,在借鉴国内外成熟的全民医保制度的基础上,提出开源与节流保障基金收支平衡,发挥社区医院在基本疾病诊治中的作用,建立医保谈判机制及成立跨部门的医疗协调机构等完善南通市全民医保制度的一些建议。
[Abstract]:For a long time, it has been our common people's dream to have a doctor. The traditional labor security system for urban staff and workers, the public medical system and the rural cooperative medical system have been unable to keep up with the needs of economic and social development. "it is difficult to see a doctor and expensive to see a doctor" has become the most prominent problem in the medical treatment of the common people. From the experience of development at home and abroad, to solve this problem, the only way to solve this problem is to develop universal health care system. As the second batch of pilot cities for the reform of the medical insurance system determined by the State Council, Nantong City has established a basic medical security system covering urban and rural people in the city after more than a decade of efforts since the reform of the medical security system in 1997. From the coverage of the system, Nantong City has entered the age of universal health insurance. However, the full coverage of the system is only the first step in implementing the road of universal medical insurance. Nantong City is now working to raise the level of medical security for the masses, so as to increase the total coverage of national health insurance from the full coverage of the system to the full coverage of the level and ability of security. In Nantong, where everyone enjoys medical security, the design of medical insurance system concerns the vital interests of millions of insured people. In the practice of the universal medical insurance system, Nantong cannot completely copy the ready-made model at home and abroad. Therefore, Nantong cannot develop the road of universal health insurance in line with the local conditions and is bound to face all kinds of challenges. It is also inevitable that some problems arise. In this paper, from the perspective of Nantong medical security system experienced and practitioners, the use of public management theory knowledge, the use of literature research, comparative analysis, field investigation, analysis and induction and other research methods, a systematic summary, This paper analyzes the development course and current situation of Nantong universal medical insurance system, deeply excavates the problems existing in the operation of the system, and analyzes the causes of these problems, on the basis of drawing lessons from the mature universal medical insurance system at home and abroad. Some suggestions on how to improve the universal medical insurance system in Nantong are put forward, such as the balance of income and expenditure of the fund, the role of community hospitals in the diagnosis and treatment of basic diseases, the establishment of medical insurance negotiation mechanism and the establishment of inter-departmental medical coordination agencies.
【学位授予单位】：南京理工大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684;D632.1

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