發(fā)布時間：2018-11-27 19:17

【摘要】：2012年8月30日,人社部、衛(wèi)生部、財政部等六部委聯(lián)合發(fā)布《關(guān)于開展城鄉(xiāng)居民大病保險工作的指導(dǎo)意見》,對于新農(nóng)合參保人員和城鎮(zhèn)居民醫(yī)保大病負擔重的這一問題,引入市場機制,建立大病保險制度,減輕城鄉(xiāng)居民的大病負擔。該制度是基本醫(yī)療保險報銷后對城鎮(zhèn)居民醫(yī)保和新農(nóng)合參保人的“二次報銷”,制度的優(yōu)勢顯而易見,有力的緩解了許多大病患者的個人負擔。然而,在對大病保險制度的研究中,更多的人將研究的目光聚焦在大病保險的經(jīng)辦模式選擇以及國外醫(yī)療保險制度的借鑒上,缺乏根據(jù)我國實際情況因地制宜的實證研究,特別是未來大病醫(yī)療保險基金收支的平衡問題,這一問題將關(guān)系到制度能否真正持續(xù)的運行下去。遼寧省是在全國范圍內(nèi)率先開展大病保險業(yè)務(wù)的地區(qū)之一。2013年3月,遼寧省農(nóng)村居民大病保險業(yè)務(wù)試點工作開始正式啟動,由于農(nóng)村的經(jīng)濟發(fā)展水平、醫(yī)療水平、人均可支配收入低于城市,致使農(nóng)村居民在面臨大病風險支出時更加脆弱,因病致貧、因貧返貧的問題更容易發(fā)生。同時,從制度實際運行來看,遼寧省農(nóng)村大病保險有著救治大病患者數(shù)量多、支出大的特點。2016年全省農(nóng)村居民大病保險共補償新農(nóng)合患者10.59萬人次,大病保險補償支出4.67億元,在這樣的背景下,遼寧省農(nóng)村未來的大病保險收支很難平衡,收不抵支的基金將難以為繼,制度實施的可持續(xù)性也將不能得到保障,對遼寧省未來農(nóng)村大病保險的收支測算十分必要,以達到大病保險制度動態(tài)調(diào)整的目標,應(yīng)對基金風險與挑戰(zhàn),從而更好的滿足遼寧省農(nóng)村居民的醫(yī)療保障需求水平。本文主要包括五個部分的內(nèi)容:第一部分為相關(guān)概念界定與理論基礎(chǔ),對大病及大病保險的相關(guān)概念進行界定,同時,選取相關(guān)理論作為本文研究的理論基礎(chǔ);第二部分為遼寧省農(nóng)村大病保險的實施現(xiàn)狀與問題,論述遼寧省農(nóng)村大病保險制度當前的實施情況,探討了與遼寧省農(nóng)村大病保險收支的相關(guān)問題;第三部分為遼寧省農(nóng)村大病保險收支平衡影響因素的實證分析,探尋影響遼寧省農(nóng)村大病保險基金收支的因素,運用主成分分析法對各項指標進行分析,找出影響的主要因素進行重點分析;第四部分為遼寧省農(nóng)村大病保險基金收支測算,分別設(shè)立大病保險基金收入與支出模型,考察大病保險未來的收支情況。通過預(yù)測未來遼寧省新農(nóng)合基金的收支情況,考察新農(nóng)合基金是否有進行大病保險補償支出的能力以及引入大病保險制度對新農(nóng)合基金有何種影響;第六部分為結(jié)論及對策建議,根據(jù)本文研究得出結(jié)論并做出說明,提出實現(xiàn)遼寧省大病保險收支平衡問題的對策及建議。
[Abstract]:On August 30, 2012, the Ministry of people's and Social Affairs, the Ministry of Health, the Ministry of Finance, and other six ministries jointly issued the guiding opinions on the Development of serious illness Insurance for Urban and Rural residents, which is an issue of heavy medical care burden for new rural co-operative insurance workers and urban residents. Introduce market mechanism, establish a serious illness insurance system, reduce the burden of serious illness of urban and rural residents. This system is the "second reimbursement" of the urban residents' medical insurance and the new rural cooperative insured after the reimbursement of basic medical insurance. The advantages of the system are obvious, which can alleviate the personal burden of many seriously ill patients. However, in the study of the serious illness insurance system, more people focus their attention on the choice of the management mode of the serious illness insurance and the reference of the foreign medical insurance system, and lack of empirical research according to the actual situation of our country. Especially the problem of balance of income and expenditure of medical insurance fund for serious illness in the future, this problem will affect whether the system can really continue to run. Liaoning Province is one of the first regions in the country to carry out serious illness insurance business. In March 2013, the pilot work of serious illness insurance for rural residents in Liaoning Province began to be officially started. Due to the level of economic development in rural areas, the level of medical treatment, The per capita disposable income is lower than that in urban areas, which makes rural residents more vulnerable when they face the risk of serious illness. At the same time, from the point of view of the actual operation of the system, Liaoning Province's rural serious illness insurance has the characteristics of large number of patients who are seriously ill and large expenditure. In 2016, the rural residents' serious illness insurance of the whole province compensated 105900 new rural cooperative patients. Under such a background, it is very difficult to balance the income and expenditure of the rural areas of Liaoning Province in the future of serious illness insurance, and the funds that receive or not offset will be difficult to sustain, and the sustainability of the implementation of the system will also not be guaranteed. It is necessary to measure the income and expenditure of Liaoning Province's future rural serious illness insurance, in order to achieve the goal of dynamic adjustment of the serious illness insurance system, to deal with the fund risks and challenges, so as to better meet the level of medical security needs of rural residents in Liaoning Province. This paper mainly includes five parts: the first part is the definition of related concepts and theoretical basis, the definition of serious illness and serious illness insurance related concepts, at the same time, select the relevant theory as the theoretical basis of this study; The second part is about the status quo and problems of rural serious illness insurance in Liaoning Province, discusses the current implementation of Liaoning Province rural serious illness insurance system, and discusses the related issues related to the income and expenditure of Liaoning Province rural serious illness insurance. The third part is the empirical analysis of the factors affecting the balance of income and expenditure of the rural major illness insurance in Liaoning Province, and explores the factors that affect the income and expenditure of the insurance fund of the rural major illness in Liaoning Province. The principal component analysis method is used to analyze the various indicators. Find out the main factors affecting the analysis; The fourth part is the calculation of the income and expenditure of the rural serious illness insurance fund in Liaoning Province. The model of income and expenditure of the serious illness insurance fund is set up to investigate the future income and expenditure of the serious illness insurance. Through forecasting the income and expenditure of the new rural cooperative fund in Liaoning province, this paper investigates whether the new rural cooperative fund has the ability to compensate the expenditure of the serious illness insurance and what influence the introduction of the serious illness insurance system has on the new rural cooperative fund. The sixth part is the conclusion and the countermeasure suggestion, according to the research conclusion and the explanation, puts forward the countermeasure and the suggestion to realize the Liaoning Province serious illness insurance income and expenditure balance problem.
【學位授予單位】：遼寧大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：F842.684;F323.89

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本文編號：2361779