城鎮(zhèn)居民重大疾病醫(yī)療保險實施現(xiàn)狀研究

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摘要 隨著我國醫(yī)療保險事業(yè)的不斷發(fā)展，群眾的醫(yī)療衛(wèi)生需求得到了初步的保障，但群眾對重大疾病醫(yī)療費用負擔(dān)重的問題依然嚴(yán)重。實行城鄉(xiāng)居民重大疾病保險工作，基本醫(yī)療得到保障的條件下，對群眾患上需要支付巨大醫(yī)療費用的重大疾病時提供的補充性保障制度，其宗旨是減輕群眾重大疾病醫(yī)療負擔(dān)防止因重大疾病導(dǎo)致貧困，使絕大部分人不會再因為疾病陷入經(jīng)濟困境。在具體的實施過程中存在著重大疾病醫(yī)療保險概念的界定不同，經(jīng)辦主體服務(wù)能力不足，保障水平有差異，籌資機制缺乏長效性，等一系列問題。本文進一步對城鎮(zhèn)居民重大疾病醫(yī)療保險的的定義界定、經(jīng)辦機構(gòu)、籌資機制、基金管理、和保障水平方面的現(xiàn)狀和存在的問題進行分析，并介紹國內(nèi)外重大疾病醫(yī)療保險總結(jié)先進經(jīng)驗。最后，根據(jù)問題提出完善重大疾病醫(yī)療保險制度建議：①重大疾病門診按病種界定；②住院按醫(yī)療費用界定大??；③提高經(jīng)辦機構(gòu)服務(wù)能力；④完善籌資機制；⑤完善重大疾病醫(yī)療保險的制度體系。

關(guān)鍵詞：重大疾病 醫(yī)療保險 現(xiàn)狀 對策

Abstract In recent years, With the establishment of universal health care system, the people have a basic guarantee of medical treatment, but the people's burden of catastrophic medical expenses reflect still more strongly. Urban and rural residents to carry out the work of serious illness insurance, basic medical insurance is based on the high medical costs of illness in patients given a further guarantee of institutional arrangements, The purpose is to address the strong masses "poverty caused by illness" issue, so most people will not be financial hardship due to illness. There is a definition of the concept of critical illness health insurance is different from handling the subject is not clear, there are differences in the level of protection, lower overall level, not on the funding criteria, deductibles, payment ratio and other key issues in the implementation process to give a specific uniform clearly defined, from serious illness insurance pay-line design is not reasonable and serious illness insurance is not reasonable pricing mechanism and other issues. Current situation and problems of the further definition of urban residents medical insurance critical illness definition, agencies, funding mechanisms, fund management, and the level of protection aspects are analyzed in this article, and introduces major disease advanced experience at home and abroad health insurance summary Finally, according to the issues raised major diseases to improve the medical insurance system suggested: ① major diseases clinic as defined by disease; ② inpatient medical expenses as defined by illness; ③ improve agency service capabilities; ④ improve financing mechanisms; ⑤ improve critical illness health insurance institutional system.

Keywords: Major illness Medical Insurance Current situation
Countermeasure


目錄
第1章 緒論 1
1.1研究背景 1
1.2研究目的和意義 1
1.2.1 研究目的 1
1.2.2 研究意義 2
1.3 國內(nèi)外綜述 2
1.3.1國外研究綜述 2
1.3.2 國內(nèi)研究綜述 3
第2章 基本概念及相關(guān)理論 4
2.1 基本概念 4
2.1.1醫(yī)療保險 4
2.1.2重大疾病 4
2.1.3 重大疾病醫(yī)療保險 5
2.2相關(guān)理論 5
2.2.1 供需理論 5
2.2.2 公共產(chǎn)品理論 6
第3章 城鎮(zhèn)居民重大疾病醫(yī)療保險制度的現(xiàn)狀分析 6
3.1基本情況 6
3.1.1 重大疾病醫(yī)療保險的由來和發(fā)展 6
3.1.2 籌資機制 7
3.1.3 經(jīng)辦機構(gòu) 7
3.1.3 保障水平 8
3.2 存在的問題 9
3.2.1 重大疾病醫(yī)療保險的界定混亂 9
3.2.2 缺乏專業(yè)化人才隊伍 9
3.2.3 缺乏籌資長效機制 10
3.2.4 保障水平較低且有差異 11
3.3存在問題的原因分析 11
3.3.1 法律法規(guī)不健全 11
3.3.2 缺乏監(jiān)管機制 12
3.3.3客觀條件差異性 12
第4章 美、英兩國重大疾病醫(yī)療保險制度實踐及借鑒 13
4.1 美國重大疾病醫(yī)療保險制度 13
4.2 英國重大疾病保險制度 13
4.3借鑒意義 14
第5章 完善城鎮(zhèn)居民重大疾病醫(yī)療保險制度的對策建議 15
5.1統(tǒng)一重大疾病的定義 15
5.2加快專業(yè)化人才隊伍建設(shè) 15
5.3 完善籌資機制 16
5.3.1明確籌資標(biāo)準(zhǔn) 16
5.3.2 建立獨立的重大疾病醫(yī)療保險籌資渠道 16
5.4 完善重大疾病醫(yī)療保險的制度體系 17
5.4.1 健全相關(guān)法律法規(guī) 17
5.4.2 建立監(jiān)管機制 18
結(jié) 論 18
致 謝 19
參考文獻 20