【作者】 黎成；

【导师】 鱼敏；

【作者基本信息】 第四军医大学 ， 社会医学与卫生事业管理， 2011， 博士

【摘要】 人人享有基本卫生服务即全体公民可获取公平的、可负担的、必需的基本卫生服务。在目前人口老年化加速、疾病谱由传染性疾病向慢性非传染性疾病转型、高新医疗技术发展迅速、人群对卫生保健期望增加的背景下,卫生系统正面临着医疗卫生资源的有限性和人群卫生服务需求日益增加的挑战。如何构建一个高效的卫生筹资体系去应对这些挑战成为世界各国政府努力解决的难题。在中国经济快速增长的背景下,中国政府正致力于建立以人为本的可持续发展的和谐社会主义社会,医疗卫生问题成为政府需要迫切解决的关系广大人民切身利益的民生问题,而建立覆盖全民的医疗保险体系是确保人人享有基本卫生服务的筹资选择和制度保障。本研究致力于在新一轮医药卫生体制改革逐步推开的背景下,进一步探讨如何建立高效的全民医疗保险体系以实现人人享有基本卫生服务的目标,从而为国家相关机关的科学决策提供理论依据和参考。本研究正是基于以上背景和目的,综合运用文献分析、历史研究、现状研究、比较研究、案例研究等方法,基于人人享有基本卫生服务内涵的剖析,通过我国基本医疗保险体系建设的现状分析、国内和国际案例的比较研究,利用卫生经济学基本原理,从卫生系统公平和效率的视角,对如何进一步完善我国全民医疗保险体系建设进行了深入思考和探讨,在此基础上提出了完善我国全民医疗保险体系改革的主要政策建议以及需要深入研究的方向:第一、进一步缩小面向不同人群的保障方案之间保障水平的差异,提高卫生服务利用的公平性;第二、提高基本医疗保险风险分担层次,由县、地级统筹逐步过渡到省级统筹,最终实现国家统筹;第三、积极尝试和推进支付方式改革,由按项目付费向预付制转变;第四、进一步全面加强基层医疗卫生机构建设,逐步建立双向转诊体系;第五、逐步实现新农村合作医疗和城镇居民基本医疗保险的整合,最终实现城乡一体化保障;第六、逐步开展门诊统筹,个人账户使用的合理性值得探讨;第七、由自愿参保适时过渡到强制参保;最后,如何激励买方发挥有效购买的作用需要深入实践和研究。更多还原

【Abstract】 Universal coverage of health care means that every citizen can access equitable, affordable and adequate health care. With the aging population, transition of disease pattern from communicable disease to chronic non-communicable disease, rapid advances in the high-technology and increasing demand of population, health system is facing the challenges of limited health resources and expanding demand of health care. How to develop an efficient health financing system to address these challenges has become an important issue that every country in the world is striving to solve.In the context of rapid economic growth, the Chinese government is trying to develop a people-oriented, sustainable and harmonious society. The issue of health care is closely related to the livelihood of population and needs to be improved urgently. Developing a universal health insurance system is the financing option that can realize the objective of universal coverage of heath care. This study aims to explore how to develop an efficient universal health insurance system under the background of ongoing health reform so as to achieve the objective of universal coverage of health care, which can also provide useful insights and scientific evidence for further reform and policy making.On the basis of background and objectives presented above, this thesis discussed and explored deeply the issue on how to further improve China’s universal health insurance system by synthetically using the research method of literature review, historical study, comparative study, empirical study and case study. Finally, using basic principles of health economics, from the perspective of equity and efficiency we proposed relevant policy suggestions and research directions in the future. First, the inequity in the benefits across different schemes should further be reduced so as to improve the equity in health care utilization. Second, the low risk pooling level should further be raised to provincial level and eventually to national level. Third, the current payment system should be transformed from FFS to prospective payment system. Fourth, the infrastructure of primary health care should be further strengthened to gradually establish a two-way referral system. Fifth, the Urban Resident Basic Medical Insurance scheme and New Rural Cooperative Medical Scheme should be integrated in future to achieve the objective of equity in access to health care between urban and rural population. Sixth, the development of MSAs is questionable and outpatient health care should be gradually covered in the benefit package. Seventh, it is necessary to change from voluntary enrollment to mandatory participation when mature, and finally, how to encourage the purchaser to play a prudent and efficient role needs further research and experiment in the future.更多还原