城乡居民大病医疗保险问题研究 ——以h市为例-research on medical insurance for serious diseases of urban and rural residents —— taking h city as an example.docxVIP

万方数据 万方数据 摘 要 城乡居民大病医疗保险制度采用商业保险公司经办的做法,目的是引入竞争 机制,提高经办效率和质量，这也是当前新公共管理运动的基本要求。大病医疗 保险制度在 28 个省份范围内试点后，于 2015 年开始在全国范围内全面推广，作 为一项保障人民群众避免因重大疾病而导致贫困的惠民利民政策，确实在一定程 度上减轻了重大疾病参保患者的医疗负担，对医疗体制改革起着积极推动作用， 但在实际实施过程中也出现了一些问题。为了较为科学的分析大病医疗保险政策 实施情况，本文以 H 市城乡居民大病医疗保险为例，从界定大病医疗、城乡居民 等概念出发，对我国大病医疗保险的发展历程进行了回顾，通过对 H 市城乡居民 问卷调查和统计分析粗略得到了 H 市城乡居民政策满意度等指标，运用专业的数 据分析软件对 H 市城乡居民大病医疗保险住院报销数据进行了统计分析，较为科 学准确的得到 H 市城乡居民大病医疗保险补偿后实际报销比率等指标，并通过这 些数据指标分析出了实际报销比率偏低、筹资水平较低、大病医疗保险基金支出 压力较大、报销程序繁琐等问题并对问题的原因进行了剖析。通过对国内商业保 险机构参与大病保险主要模式进行分析，借鉴英国、美国、德国大病医疗保障的 成功经验，为 H 市大病医疗保险健康可持续发展提出了完善大病医疗保险法律法 规，拓宽大病医疗保险基金筹资渠道，适当动态调整政策参数，优化支出结构， 推动医保付费方式改革，控制医疗费用过快增长等对策建议。 关键词:大病；医疗保险；城乡居民 I ABSTRACT The medical insurance system for urban and rural residents in 28 provinces within the scope of the pilot, to promote comprehensive nationwide in 2015, as a guarantee the people to avoid major disease caused poverty policy, to a certain extent, reduce the medical burden of patients with major disease insurance, the medical system reform plays actively promote the role, but there are some problems in the actual implementation process. In order to more scientific analysis of medical insurance policy implementation, according to the medical insurance for urban and rural residents of H city as an example, from the definition of ill health of urban and rural residents, such as the concept, the development process of medical insurance in China are reviewed, the residents through questionnaire survey and statistical analysis of urban and rural residents has been rough H policy the satisfaction index of H in urban and rural areas, the use of data analysis software professional statistical analysis of the data of medical insurance reimbursement for urban and rural residents of H city hospital, more scientific and accurate H city urban and rural residents illness insurance compensation after the actual reimbursement ratio and other indicators, and through the data analysis to calculate the actual reimbursement ratio is low, fin