构建城乡居民大病保险良性机制研究

发布时间：2018-03-23 19:45

本文选题：大病保险　切入点：良性机制　出处：《湖南师范大学》2014年硕士论文

【摘要】：我国的医疗保障体系历经十多年的改革与发展,取得了十分突出的成绩。以基本医疗保障为主体、其他多种形式补充的医疗保险,以及商业保险为补充、覆盖城乡居民的多层次医疗保障体系已初步建立,但总体上来说,保障制度和保障水平还较低,抵御大病风险的能力不强,个人大病医疗费用负担仍然很重,迫切需要建立重特大疾病保障机制。 2012年8月,国家发展改革委、卫生部、财政部、人力资源社会保障部、民政部、保监会六个部门联合发布《关于开展城乡居民大病保险工作的指导意见》,这一意见的发布意味着我国医疗保障水平的进一步提升。随着新政策的实施,看病难、看病贵的问题得到一定程度上的缓解,大病保险作为一项创新性实施项目,在政策运行过程中,还存在着较多的问题,其良性机制的构建有助于大病政策效用的发挥。本研究从筹资机制、保障内容、承办方式三方面分析了大病保险制度设计的合理性,并在此基础上,以湖南省试点城市——郴州为调查地点进行实践调研,总结了大病保险的发展状况,分析了大病保险的难点、重点所在：政策宣传、保险赔付、统筹监管、医疗费用等问题,提出了合理的可行性建议：建立合理筹资机制、风险联动机制,明确双方责任,完善商业保险公司参与大病保险的机制设计,利用税收激励,提高保险公司参与积极性,一体化管理等。试图探索出大病保险的良性机制,为大病保险项目持续稳定的发展保驾护航。
[Abstract]:After more than a decade of reform and development, China's medical security system has made outstanding achievements. With basic medical security as the main body, other forms of supplementary medical insurance, as well as commercial insurance, A multi-level medical security system covering urban and rural residents has been initially established, but on the whole, the security system and security level are still relatively low, the ability to resist the risk of serious illness is not strong, and the burden of individual medical expenses for serious illness is still very heavy. There is an urgent need to establish a major disease protection mechanism. In August 2012, the National Development and Reform Commission, the Ministry of Health, the Ministry of Finance, the Ministry of Human Resources and Social Security, the Ministry of Civil Affairs, The CIRC's six departments jointly issued a "guidance opinion on the Development of Major illness Insurance for Urban and Rural residents." the release of this opinion means that the level of medical security in China has been further improved. With the implementation of the new policy, it is difficult to see a doctor. The problem of expensive medical treatment has been alleviated to a certain extent. As an innovative implementation project, there are still many problems in the process of policy operation. This study analyzes the rationality of the design of the serious illness insurance system from three aspects of the financing mechanism, the content of the guarantee and the way of undertaking, and on this basis, taking Chenzhou, the pilot city of Hunan Province, as the investigation site, carries on the practice investigation. This paper summarizes the development of the serious illness insurance, analyzes on the difficulties of the serious illness insurance, focuses on the following problems: policy propaganda, insurance indemnity, overall supervision, medical expenses, and so on, and puts forward some reasonable feasible suggestions: establishing reasonable financing mechanism, The mechanism of risk linkage, clarifying the responsibilities of both sides, perfecting the mechanism design of commercial insurance companies to participate in the insurance of serious illness, utilizing tax incentives, improving the participation enthusiasm of insurance companies and integrating management, etc., attempts to explore the benign mechanism of serious illness insurance. To ensure the sustained and stable development of the major illness insurance program.
【学位授予单位】：湖南师范大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;R197.1

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