城鎮(zhèn)居民重大疾病醫(yī)療保險(xiǎn)實(shí)施現(xiàn)狀研究

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摘要 隨著我國(guó)醫(yī)療保險(xiǎn)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(duì)重大疾病醫(yī)療費(fèi)用負(fù)擔(dān)重的問(wèn)題依然嚴(yán)重。實(shí)行城鄉(xiāng)居民重大疾病保險(xiǎn)工作，基本醫(yī)療得到保障的條件下，對(duì)群眾患上需要支付巨大醫(yī)療費(fèi)用的重大疾病時(shí)提供的補(bǔ)充性保障制度，其宗旨是減輕群眾重大疾病醫(yī)療負(fù)擔(dān)防止因重大疾病導(dǎo)致貧困，使絕大部分人不會(huì)再因?yàn)榧膊∠萑虢?jīng)濟(jì)困境。在具體的實(shí)施過(guò)程中存在著重大疾病醫(yī)療保險(xiǎn)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(jī)制缺乏長(zhǎng)效性，等一系列問(wèn)題。本文進(jìn)一步對(duì)城鎮(zhèn)居民重大疾病醫(yī)療保險(xiǎn)的的定義界定、經(jīng)辦機(jī)構(gòu)、籌資機(jī)制、基金管理、和保障水平方面的現(xiàn)狀和存在的問(wèn)題進(jìn)行分析，并介紹國(guó)內(nèi)外重大疾病醫(yī)療保險(xiǎn)總結(jié)先進(jìn)經(jīng)驗(yàn)。最后，根據(jù)問(wèn)題提出完善重大疾病醫(yī)療保險(xiǎn)制度建議：①重大疾病門(mén)診按病種界定；②住院按醫(yī)療費(fèi)用界定大?。虎厶岣呓?jīng)辦機(jī)構(gòu)服務(wù)能力；④完善籌資機(jī)制；⑤完善重大疾病醫(yī)療保險(xiǎn)的制度體系。

關(guān)鍵詞：重大疾病 醫(yī)療保險(xiǎn) 現(xiàn)狀 對(duì)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(guó)內(nèi)外綜述 2
1.3.1國(guó)外研究綜述 2
1.3.2 國(guó)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(xiǎn) 4
2.1.2重大疾病 4
2.1.3 重大疾病醫(yī)療保險(xiǎn) 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(xiǎn)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(xiǎn)的由來(lái)和發(fā)展 6
3.1.2 籌資機(jī)制 7
3.1.3 經(jīng)辦機(jī)構(gòu) 7
3.1.3 保障水平 8
3.2 存在的問(wèn)題 9
3.2.1 重大疾病醫(yī)療保險(xiǎn)的界定混亂 9
3.2.2 缺乏專業(yè)化人才隊(duì)伍 9
3.2.3 缺乏籌資長(zhǎng)效機(jī)制 10
3.2.4 保障水平較低且有差異 11
3.3存在問(wèn)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(jī)制 12
3.3.3客觀條件差異性 12
第4章 美、英兩國(guó)重大疾病醫(yī)療保險(xiǎn)制度實(shí)踐及借鑒 13
4.1 美國(guó)重大疾病醫(yī)療保險(xiǎn)制度 13
4.2 英國(guó)重大疾病保險(xiǎn)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(xiǎn)制度的對(duì)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(duì)伍建設(shè) 15
5.3 完善籌資機(jī)制 16
5.3.1明確籌資標(biāo)準(zhǔn) 16
5.3.2 建立獨(dú)立的重大疾病醫(yī)療保險(xiǎn)籌資渠道 16
5.4 完善重大疾病醫(yī)療保險(xiǎn)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(jī)制 18
結(jié) 論 18
致 謝 19
參考文獻(xiàn) 20