城镇居民基本医疗保筹资模式分析——基于就业年龄段人群-analysis on financing mode of basic medical insurance for urban residents —— based on employment age group.docx

I I 城镇居民基本医疗保险筹资模式研究 基于就业年龄段人群 摘 要 城镇居民基本医疗保险是我国最晚建立的医疗保险制度，作为医疗保障体系 的重要组成部分，自实施以来，在保障参保人健康权益、缓解“看病难、看病贵” 等方面起着积极的作用。然而根据新医改方案医疗保障制度覆盖每一个人的要求， 城镇居民医疗保险的参保率一直都不是很理想，尤其就业年龄段人群的参保率非 常低，原因在于城镇居民医疗保险的制度设计没有考虑就业年龄段居民的医疗需 求，因此城镇居民基本医疗保险筹资模式的优化格外重要。基于此本文从以下几 个部分展开： 首先概述了本文的研究背景和研究意义；其次，通过社会公平理论、逆向选 择理论和生命周期理论分析现行的城镇居民医疗保险制度的筹资模式运行现状， 并探讨了现行基于总量平衡的缴费理念存在的问题；第三部分，对我国城镇居民 医疗保险制度的发展历程进行梳理，并概括该制度的总体框架；第四部分选取上 海市作为个案，通过实证调查城镇居民医疗保险筹资模式，并探讨了影响参保率 的根本原因；第五部分提出优化城镇居民医疗保险制度筹资模式的制度设计，提 出设计依据、设计原则及优化模式，建立与年龄相关的缴费增长、并具有个人账 户的模式，同时进行可行性验证分析；第六部分是一系列完善优化城镇居民医疗 保险筹资模式的对策建议，包括调整筹资标准、加强费用控制等。 本文的创新点在于提出筹资理念的转变：从总量平衡按人均付费制到与需求 相联系，建立城镇居民医疗保险与年龄相关的缴费增长模式并与个人账户相结合。 关键词：城镇居民，筹资模式，医疗需求，与年龄挂钩 II II THE STUDY OF AGE-LINKED CONTRIBUTION MODEL OF URBAN RESIDENTS BASIC MEDICAL INSURANCETAKING SHANGHAI FOR EXAMPLE ABSTRACT Urban Residents Basic Medical Insurance，newly implemented，as an important part for medical insurance system, has played an important role in protection of urban residents in access to Medical insurance and eased the difficult and expensive medical treatment issues. While, according to the requirement of “New Medical Reform” plan that the Medical Insurance should cover every citizients; the insurance rate for urban residents medical insurance is not very satisfied, especially for working-age urban residents, for that the system design never consider the medical demand of different age groups. Therefore, it is real important to improve its comtribution model and the thesis is divided into several parts as follows: In the first place, the thesis introduces its background and its meanings; Secondly, by theory analysis, such as social equity theory, adverse selection theory and life-cycle theory and other related theories to realized that the official contribution concept bases on the overall balance, while ignoring the intra-generational balance, therefore, the second part brings up the new concept; the third part is about the development history of basic medical insurance for urban