城鎮(zhèn)職工基本醫(yī)?；鸷侠斫Y(jié)余研究

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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)外研究綜述 2
1.3.1國內(nèi)研究綜述 2
1.3.2國外研究綜述 3
第2章 研究我國城鎮(zhèn)職工基本醫(yī)?；鸷侠斫Y(jié)余的理論依據(jù) 4
2.1基本概念 4
2.1.1城鎮(zhèn)職工 4
2.1.2城鎮(zhèn)職工基本醫(yī)療保險(xiǎn) 4
2.1.3基本醫(yī)療保險(xiǎn)基金構(gòu)成 4
2.1.4基本醫(yī)療保險(xiǎn)基金結(jié)余 4
2.2相關(guān)理論 5
2.2.1公共物品理論 5
2.2.2風(fēng)險(xiǎn)管理理論 5
第3章 城鎮(zhèn)職工醫(yī)?；鸾Y(jié)余現(xiàn)狀、問題及原因分析 6
3.1城鎮(zhèn)職工醫(yī)?；鸾Y(jié)余基本情況 6
3.1.1城鎮(zhèn)職工醫(yī)藥費(fèi)用與醫(yī)?；鹬С?6
3.1.2 城鎮(zhèn)職工醫(yī)?；鹗褂眯?6
3.1.3城鎮(zhèn)職工基本醫(yī)?；鹗罩Ъ敖Y(jié)余 7
3.2城鎮(zhèn)職工基本醫(yī)?；鸾Y(jié)余存在的問題及原因分析 8
3.2.1醫(yī)?；鹬С霾缓侠恚t(yī)療負(fù)擔(dān)加重 8
3.2.2醫(yī)?；鹗褂眯实?8
3.2.3城鎮(zhèn)職工醫(yī)?；鸾Y(jié)余過多 9
第4章 國外社會(huì)醫(yī)療保險(xiǎn)基金結(jié)余經(jīng)驗(yàn)的借鑒 9
4.1國外社會(huì)醫(yī)療保險(xiǎn)基金支付模式 9
4.1.1日本社會(huì)醫(yī)療保險(xiǎn)基金支付模式 9
4.1.2 加拿大醫(yī)療保險(xiǎn)基金支付模式 10
4.2國外社會(huì)醫(yī)療保險(xiǎn)基金結(jié)余對(duì)我國的啟示 11
4.2.1日本 11
4.2.2加拿大 11
第5章 城鎮(zhèn)職工醫(yī)?；鸾Y(jié)余問題的對(duì)策建議 12
5.1提高城鎮(zhèn)職工醫(yī)保待遇水平 12
5.2改善職工醫(yī)?；鹗褂眯?12
5.3保持職工醫(yī)?；鸷侠斫Y(jié)余 13
結(jié)論 14
致謝 16
參考文獻(xiàn) 17


摘要 伴隨我國城鎮(zhèn)職工醫(yī)療保險(xiǎn)制度的不斷完善，醫(yī)療保險(xiǎn)管理水平得到了進(jìn)一步提升，在滿足職工基本醫(yī)療保險(xiǎn)需求的同時(shí)，出現(xiàn)了基本醫(yī)?；鹗罩Р黄胶狻⑹褂眯实偷葐栴}。許多原因?qū)е逻@些問題，其中“新醫(yī)改”未能有效提高參保人員的待遇水平是這些問題出現(xiàn)的重要因素之一。截止2013年底，全年城鎮(zhèn)基本醫(yī)療保險(xiǎn)基金總收入8248億元，支出6801億元。年末城鎮(zhèn)基本醫(yī)療統(tǒng)籌基金累計(jì)結(jié)存5794億元（含城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)基金累計(jì)結(jié)存987億元），個(gè)人賬戶積累3323億元?；踞t(yī)療保險(xiǎn)基金結(jié)余過多與其保持的低標(biāo)準(zhǔn)醫(yī)保待遇是廣大城鎮(zhèn)職工關(guān)心和很多專家學(xué)者談?wù)摰暮诵摹１疚膰@這一核心問題，首先分析城鎮(zhèn)職工醫(yī)?；鹗罩Ъ敖Y(jié)余情況；其次找出基金運(yùn)行中存在的問題；再次分析產(chǎn)生這些問題的原因，最后提出相關(guān)對(duì)策建議。實(shí)現(xiàn)對(duì)我國職工醫(yī)療保險(xiǎn)基金的有效管理，使醫(yī)療保險(xiǎn)基金保持合理結(jié)余，真正提升參保人員的醫(yī)療保險(xiǎn)待遇水平。
關(guān)鍵詞: 醫(yī)?；? 基金結(jié)余 低標(biāo)準(zhǔn)醫(yī)保待遇


Research on balance of Basic Medical Insurance
Fund for Urban Worker
Abstract With the medical insurance system for urban workers in China continue to improve， the medical insurance management level has been further improved， to meet the demand of the basic medical insurance at the same time arise the problem of basic medical insurance fund imbalances and fund using low efficiency. Many reasons lead to these problems， the "new medical reform" has failed to effectively improve the insured pay level is one of the important factors of these problems. By the end of 2013， The total income of the annual urban basic medical insurance fund is 824.8 billion yuan， the expenditure is 680.1 billion yuan. The surplus of the urban basic medical overall fund accumulated to 579.4 billion yuan， personal accounts accumulated to 332.3 billion yuan. The fund surplus and maintain the low standard of medical insurance treatment has become the urban workers concern and the focus of many experts to discuss. This paper first analyzed urban worker medical insurance fund balance; Then find out the problems existing in the fund operation; Once again to dig deeper into the reasons of these problems; Finally puts forward relevant suggestions. Realize the effective management of medical insurance fund in China， and maintain medical insurance fund reasonable balance.really improve the insured medical insurance level.
Key words Medical Insurance Fund Surplus of Fund Low Standard Health Care Treatment