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绵阳市整合城乡居民基本医疗保险制度的研究_MBA毕业论文DOC

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文本描述
摘要
我国已经建成了以城镇职工基本医疗保险制度、新型农村合作医疗、城镇居
民基本医疗制度和城乡医疗救助制度为主体的具有中国特色的基本医疗保障体
系,覆盖人数超过了 13 亿人口,全民医保体系已基本形成。然而随着社会的深入
发展,这种城乡二元制户籍下形成的城乡二元化的医疗保障制度的弊端也日益显
现出来,主要表现在缺乏社会公平性、不利于人力资源的流动、不利于医疗保险
制度的可持续发展,同时造成了财政部门进行的重复财政补贴、城乡居民的重复
参保现象、相关部门重复的建立信息系统和经办机构等系列问题。解决这一系列
问题最有效的方式是实现我国基本医疗保险的城乡统筹

早些年,国务院曾提出过“三保合一”即城镇职工基本医疗保险制度、新型
农村合作医疗、城镇居民基本医疗保险制度三制度合一的目标,由于现目前三种
制度在缴费标准和待遇享受方面还存在着较大的差异,“三保合一”并不能马上实
现,而新型农村合作医疗和城镇居民基本医疗保险的“两保合一”却是具备了足
够的社会经济条件,他们具有相似的参保原则、筹资标准和筹资模式

本文采用了比较分析法和案例分析法,首先对整合城乡居民基本医疗保险的
研究背景研究意义、文献综述和相关理论基础进行了介绍,其次对我国现行的基
本医疗保险发展历程现状结构进行了梳理并提出了其存在的问题和对社会发展的
影响,再次分析了整合城乡居民基本医疗保险的可行性和意义,最后以绵阳市整
合城乡居民基本医疗保险为例,从绵阳市城乡居民基本医疗保险的参保对象、筹
资机制、筹资水平、待遇和补偿水平、基金和组织管理这五个方面分别进行两种
制度的对比分析,分析整合存在的问题,同时借鉴国内整合城乡居民基本医疗保
险的试点的先驱城市成都市和常熟市的经验,主要从统一覆盖人群、统一筹资方
式、统一筹资标准、统一补偿机制、基金风险控制和统一管理体制六个方面为绵
阳市整合城乡居民基本医疗保险工作提出主要思路和建议

关键词:城乡居民;整合;基本医疗保险西南科技大学硕士研究生学位论文
第 II页
Abstract
Our country has built a basic medical insurance system for urban workers, the
new rural cooperative medical care and urban residents basic medical care system and
urban and rural medical assistance system as the main body has the characteristics of
China basic medical security system, covering more than 1 billion 300 million of the
population, the national health insurance system has been basically formed. However,
with the further development of the society, abuse of medical security system formed
the two urban and rural household registration system under the two yuan in urban and
rural areas are increasingly apparent, mainly manifested in the lack of social fairness,
sustainable development is not conducive to the flow of human resources, is not
conducive to the medical insurance system, at the same time by the Finance
Department of the Treasury repeated subsidies, urban and rural residents insured repeat
phenomenon, relevant departments repeatedly set up information system and a series
of problems such as agency. The most effective way to solve this series of problems is
to realize the balance of urban and rural medical insurance in China. Earlier this year,
the State Council has put forward the Three Guarantees is the basic medical
insurance system for urban workers, the new rural cooperative medical care and basic
medical insurance system for urban residents of three systems in one goal, because the
current system in three kinds of payment standards and enjoy treatment, there are still
large differences, the three guarantees one and can not be achieved immediately, and
the new rural cooperative medical care and basic medical insurance for urban residents
of the two guarantees is to have enough social and economic conditions, they are
similar to the principle of insurance, financing standard and financing mode.
This paper uses the theory and method of comparative analysis and case analysis,
in Mianyang City, integration of urban and rural residents basic medical insurance as
an example, from the basic medical insurance for urban and rural residents in
Mianyang City, insurance, financing mechanism, financing level, treatment and西南科技大学硕士研究生学位论文
第 III页
compensation level, fund and organization management in the five aspects of
comparative analysis of two system integration, analysis of existing problems, and
from Chengdu city and Changshu City domestic integration of urban and rural
residents basic medical insurance pilot precursor city experience, mainly from the
unity of the people covered, puts forward the main ideas and suggestions on six aspects
of a unified way of financing, the financing standard, unified compensation mechanism,
fund risk control and unified management system Mianyang City, the integration of
urban and rural residents basic medical insurance.
Keyword: Urban and rural residents; Integration; Basic medical
insurance西南科技大学硕士研究生学位论文
第 IV页
目 录
1 绪论.....1
1.1 研究背景及意义...........1
1.1.1 研究背景.1
1.1.2 研究意义.2
1.2 国内外文献综述...........2
1.2.1 国内文献综述.....2
1.2.2 国外文献综述.....4
1.3 研究思路和研究方法...6
1.3.1 研究思路.6
1.3.2 研究方法.7
1.4 论文的创新和不足.......7
1.4.1 论文的创新.........7
1.4.2 论文的不足.........7
2 整合城乡居民基本医疗保险的相关理论基础.........8
2.1 整合城乡居民基本医疗保险的相关概念界定...........8
2.1.1 城镇职工基本医疗保险.8
2.1.2 新型农村合作医疗.........8
2.1.3 城镇居民基本医疗保险.8
2.1.4 整合城乡居民基本医疗保险.....9
2.2 整合城乡居民基本医疗保险的相关理论.......9
2.2.1 二元经济结构理论.........9
2.2.2 公平理论...........10
2.2.3 福利经济学理论...........11
2.3 整合城乡居民基本医疗保险的必要性和可行性.....11
2.3.1 整合城乡居民基本医疗保险的必要性...........11
2.3.2 整合城乡居民基本医疗保险的可行性...........12
3 城乡居民基本医疗保险的主要发展历程和现状情况.......15西南科技大学硕士研究生学位论文
第 V页
3.1 我国城乡居民基本医疗保险的发展历程和现状情况.........15
3.1.1 新型农村合作医疗的发展历程和现状情况...15
3.1.2 我国城镇居民基本医疗保险的发展历程和现状情况...........15
3.1.3 我国现行城乡居民基本医疗保险存在的问题和对社会的影响.......16
3.2 绵阳市城乡居民基本医疗保险的现状及整合存在的问题.17
3.2.1 绵阳市城乡居民基本医疗保险的现状情况...17
3.2.2 绵阳市整合城乡居民基本医疗保险存在的问题.......23
4 国内整合城乡居民基本医疗保险试点地区的经验借鉴...26
4.1 成都模式.........26
4.1
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