【作者】 万筱明；

【导师】 刘翠；

【作者基本信息】 合肥工业大学 ， 公共管理， 2008， 硕士

【摘要】 党的十六届六中全会通过的《中共中央关于构建社会主义和谐社会若干重大问题的决定》,提出要建设覆盖城乡居民的基本卫生保健制度,目标和任务虽然明确,但要解决一个拥有13亿人口大国的医疗保障问题,仍然面临诸多困难。特别是在当前经济社会发展矛盾凸显期,如何改革我国的医疗保障体系,是当前我国医疗卫生体制改革所面临的重大课题之一。本文主要研究全民医疗保险问题,并就建立多元参与的全民医保模式进行了深入研究。本文首先详细介绍了我国各时期的医疗保险制度及其演变过程,系统分析了我国各时期医疗保险制度随着经济社会的发展所表现出来的弊端,总结了我国二十年来医疗卫生体制改革的经验、教训和今后的改革方向。在打破传统分类方法,对国外各种医疗保险模式进行分类的基础上,深入分析了国外各类型医保模式的优势、缺陷及值得借鉴的经验。通过比较研究,论文认为我国的医疗保险供给和运行模式完全可以在市场参与或市场主导下步入良性循环的发展轨道。针对我国现有医疗保险制度各种弊端,依据社会福利普及性原则和社会保险大数法则,结合我国国情和经济社会发展现状及趋势,论文提出了多元参与的全民医保模式的概念、目标及特征并进行了详细阐述,论证了医疗保险的供给必须遵循市场经济规律,符合构建社会主义和谐社会的要求。本文还运用公共产品理论、社会福利理论,研究了医疗福利产品作为公共产品通过市场实现有效供给的新途径;运用政治经济学理论,分析了政府在国民收入分配中的作用;深入探讨了城乡医保统筹发展问题。论文认为,医疗福利作为公共产品的有效供给、国民收入的合理分配、城乡卫生资源的合理配置,是落实医保政策的基础和关键。在前面研究的基础上,本文提出了实现多元参与的全民医保模式的基本思路,设计了多元参与的全民医保模式简要方案,内容主要包括:保障重点是住院等大病医疗、医保资金实行分类筹集、医疗服务产品和医疗服务机构实行分类管理,医疗服务产品实行市场供给、公共福利资源分配实行货币化及改造现有医疗网络。本文的研究是对目前我国医疗保险模式研究理论的一个补充,具有一定的理论意义;本文的研究阶段正值国家医疗卫生体制改革新方案即将出台的关键时刻,从实际操作角度出发提出的系列改革对策和建议,具有一定的时效性和前瞻性,具有重要的现实意义。更多还原

【Abstract】 The CPC Central Committee’s Decision on Some Major Issues in Building a Socialist Harmonious Society approved in the party’s Sixth Plenum of the 16th proposed to build the basic medical and health care system which covers the urban and rural residents. Although objectives and tasks are clear, we still face many difficulties in solving medical insurance problems of the country with a large population of 1.3 billion. Especially in the current economic and social development period with prominent contradictions, how to reform our country’s medical security system is one of the major subjects faced in the current reform of China’s medical and health .This paper mainly studies universal medical insurance, and conducts in-depth research on the establishment of pluralism in the popular medical insurance model.This paper first described in detail China’s medical insurance system in different periods and its evolution process, systematically analyzed its drawbacks appeared with the economical and social development, summed up the experience and lessons of medical health system reform over the past 20 years and generally decided the future direction of reform.On the basis of breaking the traditional classification and classifying various medical insurance patterns abroad, this paper deeply analyzed advantages, shortcomings of various foreign types of medical insurance model and the experience which is worth learning. Through a comparative study, the paper claims that the supply and operation of the medical insurance model can entirely step into the benign circle of development track under the market participation or the market-driven.In view of the various defects of the existing medical insurance system, based on the principle of universal social welfare and social insurance law of large numbers, in light of China’s national situation and status and trends of economic and social development, the paper presented and elaborated the concept, the objectives and characteristics of universal health-care model with a pluralistic participation. The paper also demonstrated the supply of medical insurance must follow the rules of market economy, and keep in line with the requirements of building a socialist harmonious society. This paper has also applied the theory of public goods and social welfare theory to the study of a new way of effective supply products on the medical benefits as public goods achieve through the market; this paper utilized the political economic theory to analyze the government’s role in the distribution of national income and made in-depth study of issues of the urban and rural health-care co-ordinate development. The paper indicates the effective supply of medical benefits as public goods, the rational allocation of national income, urban and rural rational resource allocation are the foundation and key policy of the implementation of medical care.On the basis of the former research, this paper presented the basic ideas of realization of pluralism in the universal medical insurance model, designed program summary of universal medical insurance model with pluralism. The contents mainly include the following aspects: The security focus is seriously ill health such as hospitalization. The medicare funds are raised with classification. The management of medical care products and medical services institutions should be classified. The medical care products implement market supply. Public welfare allocation of resources implements monetization. Transform the existing health care network. The study of this paper is a supplementary theory studying the current medical insurance model and has a certain theoretical significance.In this paper, the research stage is in a crucial moment when the new national health reform program will soon be introduced. From a practical point of view, a series of reform measures and recommendations put forward in this paper are timely and forward-looking and have important practical significance.更多还原