安徽省大病医疗互助补充保险委托商业保险公司经办依据及实施过程研究

发布时间：2018-12-17 08:43

【摘要】：安徽省于去年开展了大病医疗互助补充保险的试点工作,并要求采用保险合同模式委托商业保险公司经办,那么,为何要委托保险公司经办,保险合同模式在安徽是否适用,其实施流程是怎样的?这些都将成为本文研究的主要内容。本文首先对大病医疗互助补充保险进行了定性的分析,再基于福利多元主义理论和新公共管理理论对安徽省大病医疗互助补充保险由商业保险公司经办的必要性进行理论上验证。其次,阐述了国外和国内保险公司参与社会医疗保险的实践经历以此得出相应经验,再次,对目前出现的两种经办模式即基金管理模式和保险合同模式进行比较分析并结合实际得出保险合同模式更适用于安徽省开展大病医疗互助补充保险,最后,利用之前所得到的经验构造出这种模式的经办流程图并对其关键环节展开分析。研究表明,市场是可以参与社会医疗保险体系的构建的,一个完善的社会医疗保险体系离不开市场的作用,无论从理论还是实际方面都应证了这一点,安徽省在推行大病医疗互助补充保险的同时应充分发挥市场的作用,利用保险公司的专业优势服务于参保人,采用保险合同模式经办大病医疗互助补充保险应长期贯彻,这不仅是顺应了国外主流趋势,也是基于医保基金未来支付压力的考虑,要最大限度地发挥保险合同模式的优势应该在合同内容拟定、招标、结算、费用控制、保险公司利润约束、支付比例等环节加以重点关注。
[Abstract]:Last year, Anhui Province launched a pilot work on supplementary insurance for medical mutual assistance for serious illnesses, and requested that commercial insurance companies be entrusted with handling it under the insurance contract model. So, why should insurance companies be entrusted with handling it, and whether the insurance contract model is applicable in Anhui? What is the implementation process? These will become the main content of this paper. This article first carries on the qualitative analysis to the serious illness medical mutual aid supplementary insurance, Based on the theory of welfare pluralism and the new public management theory, the necessity of supplementary medical mutual insurance in Anhui Province by commercial insurance companies is theoretically verified. Secondly, expound the experience of insurance companies in social medical insurance in foreign and domestic countries to get the corresponding experience. Again, This paper makes a comparative analysis of the two kinds of operational modes, fund management mode and insurance contract mode, and concludes that the insurance contract model is more suitable for Anhui Province to carry out supplementary insurance for medical assistance in serious illness. The operation flow chart of this model is constructed by using the previous experience and the key links are analyzed. The research shows that the market can participate in the construction of social medical insurance system, a perfect social medical insurance system can not be separated from the role of the market, both in theory and in practice should prove this point. Anhui Province should give full play to the role of the market while carrying out the supplementary insurance of medical mutual assistance for serious illness, make use of the professional advantages of the insurance company to serve the insured, and adopt the insurance contract model to run the supplementary insurance for the medical mutual assistance for the serious illness for a long time. This is not only in line with the mainstream trend of foreign countries, but also based on the consideration of the future payment pressure of the medical insurance fund. To maximize the advantages of the insurance contract model, the contract content should be drawn up, solicited, settled, and expenses controlled. Insurance company profit restraint, pay proportion and other links to focus attention.
【学位授予单位】：安徽财经大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;R197.1

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