我国城乡基本医疗保险制度整合研究
发布时间：2018-09-03 11:28
【摘要】：2016年1月国务院发布《关于整合城乡居民基本医疗保险制度的意见》,将原本就备受争议的医保制度整合问题再次提升为社会热点问题。计划经济时期城乡"分割"的医保制度在改革开放后逐渐被城镇职工基本医疗保险制度、城乡居民基本医疗保险制度和新型农村合作制度所取代,城乡三项基本医保制度各自独立运行,再加上城乡医疗救助制度,"三险一助"所构成的医疗保障体系在我国社会保障体系中占据重要地位。但随着市场经济体制的改革,"分割"的医保制度已经无法适应社会发展要求,重复参保问题凸显,资源浪费严重,医保管理效率低下,使得整合"分割"的基本医保制度逐渐成为社会共识。总体来看,城乡三项基本医保制度的同质性决定其制度整合的可能性,制度的差异性决定其制度整合的复杂性。长期的城乡二元分割背景下,地区间经济发展水平差异明显,导致制度整合无法在全国范围内统一实施,只能选取试点现行的办法。但各试点地区采取的整合办法地方色彩严重,没有形成统一的、具有普适性的整合办法,使原本就处于"碎片化"的医保制度,陷入"再碎片化"悖论。结合地方试点试验可以发现,新农合和城镇居民医保制度相似度高,可以先整合成为城乡居民基本医保制度,这两项制度整合的难点在于整合后的行政管理权归属问题;但这两项基本医保制度与职工基本医保制度在缴费方式、待遇支付等方面都存在巨大差异,无法直接整合,可以以城乡居民基本医保制度为过渡,逐渐缩小制度差异,为实现"三保合一"做准备。本文先通过梳理城乡三项基本医保制度内容,比较城乡三项基本医保制度间存在的异同,寻找制度间的衔接点;其次通过制度"分割"运行所暴露出来的不良效应,得出制度整合的必要性;然后通过分析整合试点的现状及其存在问题,探究制度难以整合的原因及其影响因素;最后提出整合城乡三项基本医保制度的对策建议,推进医保制度整合的顺利进行。
[Abstract]:In January 2016, the State Council issued "opinions on integrating the basic medical insurance system for urban and rural residents," raising the controversial issue of health care system integration once again to a social hot issue. After the reform and opening up, the medical insurance system of urban and rural areas was gradually replaced by the basic medical insurance system of urban and rural residents and the new rural cooperative system. The three basic medical insurance systems in urban and rural areas operate independently, and in addition to the medical assistance system in urban and rural areas, the medical security system composed of "three risks and one aid" occupies an important position in the social security system of our country. However, with the reform of the market economy system, the "split" medical insurance system has been unable to meet the needs of social development. The problem of repeated participation in insurance has become prominent, the waste of resources is serious, and the efficiency of medical insurance management is low. So that the integration of the "division" of the basic health care system has gradually become a social consensus. In general, the homogeneity of the three basic medical insurance systems in urban and rural areas determines the possibility of institutional integration, and institutional differences determine the complexity of institutional integration. Under the background of urban-rural dual division for a long time, the difference of economic development level between regions is obvious, which leads to the system integration can not be implemented uniformly in the whole country, so it can only select the current method of pilot project. However, the integration method adopted in each pilot area is serious in local color and has not formed a unified and universal integration method, which makes the medical insurance system already in "fragmentation" and falls into the paradox of "refragmentation". Combined with the local pilot test, it can be found that the new rural cooperative and urban residents medical insurance system has high similarity, and can be integrated into the basic medical insurance system of urban and rural residents first. The difficulty of the integration of these two systems lies in the ownership of administrative management rights after integration; However, these two basic medical insurance systems and the basic medical insurance system for employees have huge differences in the way of payment, payment of benefits, and so on, which cannot be directly integrated. We can take the basic medical insurance system of urban and rural residents as the transition and gradually narrow the differences in the system. Prepare for the realization of "three guarantees in one". This paper first combs the contents of the three basic medical insurance systems in urban and rural areas, compares the similarities and differences between the three basic medical insurance systems in urban and rural areas, and looks for the convergence points between the systems. Then through the analysis of the status quo and existing problems of the integration of the pilot, explore the reasons for the difficult integration of the system and its impact factors; finally, put forward the integration of urban and rural three basic health insurance system countermeasures and suggestions, To promote the smooth integration of the medical insurance system.
【学位授予单位】：山西大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.1;F842.684
本文编号：2219850
[Abstract]:In January 2016, the State Council issued "opinions on integrating the basic medical insurance system for urban and rural residents," raising the controversial issue of health care system integration once again to a social hot issue. After the reform and opening up, the medical insurance system of urban and rural areas was gradually replaced by the basic medical insurance system of urban and rural residents and the new rural cooperative system. The three basic medical insurance systems in urban and rural areas operate independently, and in addition to the medical assistance system in urban and rural areas, the medical security system composed of "three risks and one aid" occupies an important position in the social security system of our country. However, with the reform of the market economy system, the "split" medical insurance system has been unable to meet the needs of social development. The problem of repeated participation in insurance has become prominent, the waste of resources is serious, and the efficiency of medical insurance management is low. So that the integration of the "division" of the basic health care system has gradually become a social consensus. In general, the homogeneity of the three basic medical insurance systems in urban and rural areas determines the possibility of institutional integration, and institutional differences determine the complexity of institutional integration. Under the background of urban-rural dual division for a long time, the difference of economic development level between regions is obvious, which leads to the system integration can not be implemented uniformly in the whole country, so it can only select the current method of pilot project. However, the integration method adopted in each pilot area is serious in local color and has not formed a unified and universal integration method, which makes the medical insurance system already in "fragmentation" and falls into the paradox of "refragmentation". Combined with the local pilot test, it can be found that the new rural cooperative and urban residents medical insurance system has high similarity, and can be integrated into the basic medical insurance system of urban and rural residents first. The difficulty of the integration of these two systems lies in the ownership of administrative management rights after integration; However, these two basic medical insurance systems and the basic medical insurance system for employees have huge differences in the way of payment, payment of benefits, and so on, which cannot be directly integrated. We can take the basic medical insurance system of urban and rural residents as the transition and gradually narrow the differences in the system. Prepare for the realization of "three guarantees in one". This paper first combs the contents of the three basic medical insurance systems in urban and rural areas, compares the similarities and differences between the three basic medical insurance systems in urban and rural areas, and looks for the convergence points between the systems. Then through the analysis of the status quo and existing problems of the integration of the pilot, explore the reasons for the difficult integration of the system and its impact factors; finally, put forward the integration of urban and rural three basic health insurance system countermeasures and suggestions, To promote the smooth integration of the medical insurance system.
【学位授予单位】：山西大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.1;F842.684
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