北京市医疗保险基金收支平衡问题研究-保险学专业论文.docxVIP

I I 摘 要 我国城镇基本医疗保险制度及新型农村合作医疗制度的建立提高了医疗健 康水平，促进了经济与社会进一步的发展。医疗保险基金收支平衡是我国医疗保 障制度可持续发展的基础，基金的适度结余对于保障参保人员的基本医疗权益， 减轻群众医疗费用负担有着重要的意义。如何既保证参保人员“病有所医，医有 所报”，又保证医保基金收支平衡、略有结余，成为基本医疗保险改革及发展所 面临的重要课题。 本文主要研究北京市城镇职工基本医疗保险、城镇居民基本医疗保险、新型 农村合作医疗三项医疗保险制度的历史沿革，参保率及基金收入与支出情况，累 计结余情况，从基金收入方面选取了参保人数、职工平均工资、缴费比例、在职 职工比例、死亡率、政府补助和人口老龄化程度七个因素，从基金支出方面选取 了预期寿命、起付标准和最高支付限额、医疗费用报销标准、疾病谱的变化、居 民健康和保健意识、医疗科技的进步六个因素，对影响医疗保险基金收支的主要 因素进行了分析。通过借鉴国外以及我国大连、云南等地区的医疗保险基金收支 平衡管理经验，从基金管理、基金收入、基金支出三个方面对北京市医疗保险基 金收支平衡管理提出对策建议。 关键词：医疗保险，基金管理，收支平衡 II II Abstract The establishment of the urban basic medical insurance system and new rural cooperative medical system in our country has improved the health level and the development of society and economy. The balance of medical insurance fund is the foundation of the development of medical security system in China. Moderate balance of medical insurance funds is of great significance for the guarantee of people’s basic rights and interests of health care and the reducing of people’s medical expenses burden. How to guarantee both the people’s medical treatment and reimbursement and the balance of medical insurance fund is becoming the important problem faced by reform and development of medical insurance. First, I studied of the history, the rates of joining insurance, the incomes and payments of the medical insurance of Beijing urban employee basic medical insurance system, urban resident basic medical insurance and new rural cooperative medical system. Second, I analyzed the seven factors affecting the income of medical insurance including the number of insured, average wage, insurance rate, proportion of on-the-job worker, mortality, government subsidies and aging of population and the six factors affecting the payment of medical insurance including life expectancy, the lowest and highest pay limitation, the reimbursement ratio, the change of disease spectrum, the residents awareness of health and the progress of medical technology. Third, I learned the exper