【作者】 王健；

【导师】 周绿林；

【作者基本信息】 江苏大学 ， 社会医学与卫生事业管理， 2010， 硕士

【摘要】 20世纪90年代以来,城镇居民的医疗保障水平大幅下降,城镇居民医疗负担沉重。党中央、国务院高度重视解决城镇居民群体的医疗保障问题。2007年国务院颁布《关于开展城镇居民基本医疗保险试点的指导意见》,力图通过建立城镇居民基本医疗保险制度,减轻城镇居民看病就医的负担。2009年江苏省13个设区市已全部启动了城镇居民基本医疗保险制度,其覆盖范围、统筹层次、筹资机制、支付机制、基金管理、经办服务等方面的制度建设及运行效果成绩显著,但也暴露出一些问题值得探讨。本文以城镇居民基本医疗保险的内涵及理论基础研究为前提,以国外典型国家的城镇医疗保险制度改革为借鉴,以江苏省城镇居民基本医疗保险制度建设和运行效果研究为核心,探讨问题,形成政策建议,以完善江苏省城镇居民基本医疗保险制度。关于制度建设,首先阐述了江苏省城镇居民基本医疗保险制度的建设情况;其次介绍了当前城镇居民基本医疗保险制度的主要内容;再次,以无锡、盐城、泰州三个地区为样本分析比较了城镇居民基本医疗保险制度的运行机制,以反映江苏省城镇居民基本医疗保险制度运行机制的总体状况。关于运行效果,本文选择了江苏省最具代表性的常州市为样本,通过德尔菲法和层次分析法构建评价指标体系及评价模型对常州市城镇居民基本医疗保险运行效果进行评价,以反映江苏省城镇居民基本医疗保险运行效果。通过制度体制比较和运行效果分析,可以看出江苏省城镇居民基本医疗保险制度建设和运行效果总体较好。但也存在着参保对象范围窄,基金筹资渠道少,支付待遇水平低,基金监管不到位,社区卫生服务建设滞后等问题。本文从理念制度、立法保障、运行机制、服务管理、制度衔接等方面提出政策建议,以完善江苏省城镇居民基本医疗保险制度。更多还原

【Abstract】 Since the 90s of 20th century, urban resident’s medical security decreased substantially and their health burden grows. The State Council attaches great importance to solve urban population groups of medical security.In 2007, the State Council issued "pilot guidance on the basic medical insurance for urban residents", try to build basic medical insurance system and reduce burden on patients for urban residents. By 2009, 13 Cities in Jiangsu Province have all started the basic medical insurance system for urban residents. Its coverage, co-ordination level, funding mechanisms, payment mechanisms, fund management, handling services and so the system construction and operating results remarkable achievements, but also exposed some problems worth investigating.In this paper, study on the basic medical insurance for urban residents and the theory of meaning as the prerequisite to the typical foreign countries, then analyses on the urban medical insurance system for the draw, urban residents in Jiangsu Province and the operation performance in the core of the problem, the formation of policy recommendations to improve the urban residents in Jiangsu Province’s basic medical insurance system. Construction on the system, first of all, described the basic medical insurance system of urban residents in Jiangsu Province for the status quo; then introduced the current system of basic medical insurance for urban residents in the main content; Third, try to analyzes and compares samples of the basic medical insurance system for urban residents in the operating mechanism to reflect the general situation of basic medical insurance system’s operating mechanism of Wuxi, Yancheng, Taizhou three regions in Jiangsu Province. Lastly, the paper chose the most representative city Changzhou as a sample, through the Delphi method and AHP evaluation index system construction in Changzhou basic medical insurance for urban residents to evaluate the operating results to reflect the running effects of basic medical insurance in Jiangsu Province.And through the analysis of system’s operating, this paper gives urban residents in Jiangsu Province a more effective system, the basic medical insurance system for construction and operation of the overall good results. But there are also problems like narrow the scope of the insured object, the less fund sources of funding, low pay and poor supervision of funds in place, and community health services building lagged behind. From the concept of the system, legal protection, operating system, service management, system interface and other aspects of policy recommendations, this paper put forward some suggestions to improve the basic medical insurance system of urban residents in Jiangsu Province.更多还原