新型農(nóng)村合作醫(yī)療重大疾病保障水平研究

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目 錄
第1章 緒論 1
1.1研究背景 1
1.2研究目的和意義 2
1.2.1研究目的 2
1.2.2研究意義 2
1.3國(guó)內(nèi)外研究綜述 3
1.3.1國(guó)外研究綜述 3
1.3.2國(guó)內(nèi)研究綜述 4
1.3.3文獻(xiàn)評(píng)述 4
1.4研究?jī)?nèi)容 4
第2章 新農(nóng)合重大疾病保障的基本概念及理論基礎(chǔ) 5
2.1相關(guān)基本概念 5
2.1.1重大疾病 5
2.1.2重大疾病保險(xiǎn) 6
2.1.3重大疾病保障的屬性 6
2.1.4重大疾病保障的目標(biāo)定位 6
2.2理論基礎(chǔ) 7
2.2.1福利經(jīng)濟(jì)學(xué)理論 7
2.2.2公共產(chǎn)品理論 7
2.2.3風(fēng)險(xiǎn)管理理論 7
第3章 十堰市新農(nóng)合重大疾病保障的現(xiàn)狀分析 8
3.1十堰市社會(huì)經(jīng)濟(jì)環(huán)境和基本醫(yī)療保障制度概況 8
3.2十堰市新農(nóng)合重大疾病保障的現(xiàn)狀 9
3.2.1運(yùn)行模式 9
3.2.2籌資標(biāo)準(zhǔn) 9
3.2.3保障范圍 9
3.2.4補(bǔ)償標(biāo)準(zhǔn) 9
3.3十堰市重大疾病保障存在的問(wèn)題 10
3.3.1缺乏長(zhǎng)效的籌資機(jī)制 10
3.3.2保障范圍小，保障水平低 10
3.3.3農(nóng)民參與不積極 11
3.3.4合作機(jī)制不完善 11
3.4十堰市重大疾病保障存在問(wèn)題的成因 11
3.4.1缺乏立法保護(hù) 11
3.4.2政府財(cái)政投入不足 11
3.4.3宣傳不到位 12
3.4.4專(zhuān)業(yè)化程度低，管理水平低 12
第4章 國(guó)內(nèi)外重大疾病保障經(jīng)驗(yàn)及借鑒 12
4.1國(guó)外重大疾病保障基本情況 12
4.1.1英國(guó)——全民醫(yī)療保險(xiǎn) 12
4.1.2德國(guó)——法定醫(yī)療保險(xiǎn) 13
4.1.3美國(guó)——私人醫(yī)療保險(xiǎn) 13
4.1.4新加坡——健保雙全計(jì)劃 13
4.2國(guó)內(nèi)其他省市大病保險(xiǎn)運(yùn)營(yíng)情況 14
4.2.1“江陰模式”——委托管理型 14
4.2.2“太倉(cāng)模式”——全額轉(zhuǎn)保型 14
4.3借鑒啟示 15
4.3.1堅(jiān)持政府主導(dǎo) 15
4.3.2 注重預(yù)防保健 15
4.3.3引入市場(chǎng)競(jìng)爭(zhēng) 15
第5章 提高十堰市新農(nóng)合重大疾病保障水平的策略 16
5.1加強(qiáng)頂層設(shè)計(jì)，完善大病保障制度 16
5.2建立科學(xué)合理可行的籌資機(jī)制 16
5.3合理控制醫(yī)療費(fèi)用，提高基金保障績(jī)效 16
5.4加強(qiáng)監(jiān)管，促進(jìn)大病保險(xiǎn)業(yè)務(wù)規(guī)范發(fā)展 16
5.5提高經(jīng)辦機(jī)構(gòu)服務(wù)能力 17
5.6 積極推進(jìn)大病保險(xiǎn)城鄉(xiāng)統(tǒng)籌 17
結(jié) 論 18
致 謝 19
參考文獻(xiàn)： 20

摘要 健康是人最基本、最重要的權(quán)益，是促進(jìn)人的全面發(fā)展的必然要求。以人為本，在一定意義上說(shuō)，首先要以人的健康為本。重大疾病通常是指嚴(yán)重威脅人們生命和健康，并且極易帶來(lái)患者家庭沉重的經(jīng)濟(jì)負(fù)擔(dān)的疾病。新型農(nóng)村合作醫(yī)療制度（以下簡(jiǎn)稱(chēng)“新農(nóng)合”）在設(shè)立之初就強(qiáng)調(diào)了對(duì)農(nóng)民高額醫(yī)療費(fèi)用的分?jǐn)傃a(bǔ)償作用。但多年實(shí)踐證明，對(duì)于一些重大疾病，新農(nóng)合的保障補(bǔ)償作用有限， 參合農(nóng)民的經(jīng)濟(jì)負(fù)擔(dān)仍較為沉重，“因病致貧”與“因病返貧”現(xiàn)象時(shí)有發(fā)生。
在此背景下，本文立足于十堰市經(jīng)濟(jì)社會(huì)發(fā)展大局，通過(guò)分析新農(nóng)合大病保險(xiǎn)制度產(chǎn)生的背景，在綜合國(guó)內(nèi)外文獻(xiàn)和實(shí)踐的基礎(chǔ)上，明確了重大疾病的概念、大病保險(xiǎn)的屬性及目標(biāo)定位，總結(jié)了十堰市新農(nóng)合大病保險(xiǎn)的發(fā)展?fàn)顩r及存在問(wèn)題：缺乏長(zhǎng)效籌資機(jī)制；保障范圍小、保障水平偏低；農(nóng)民參與不積極等。并結(jié)合國(guó)外典型國(guó)家和國(guó)內(nèi)大病保險(xiǎn)試點(diǎn)的經(jīng)驗(yàn)對(duì)提高十堰市新農(nóng)合重大疾病保障水平提出了建議：加強(qiáng)頂層設(shè)計(jì)，完善大病保障制度；建立科學(xué)合理可行的籌資機(jī)制；合理控制醫(yī)療費(fèi)用、提高基金保障績(jī)效；加強(qiáng)監(jiān)管、促進(jìn)大病保險(xiǎn)業(yè)務(wù)規(guī)范發(fā)展；提高經(jīng)辦機(jī)構(gòu)服務(wù)能力以及積極推進(jìn)大病保險(xiǎn)城鄉(xiāng)統(tǒng)籌等。

關(guān)鍵詞：新農(nóng)合 重大疾病 大病保險(xiǎn) 保障水平

Research on Serious Disease Security Level of the New Rural
Cooperative Medical System in ShiYan City

Abstract Health is the most basic, the most important rights and interests, an inevitable requirement of promoting people's overall development. People-oriented, in a certain sense, is regarded health as the fundamentality. Serious disease usually refers to diseases that seriously threat to people's lives and health, and easy to bring heavy economic burden of disease to patients and families. The New Rural Cooperative Medical System (NCMS), at the beginning of the establishment, emphasized the role of sharing the compensation effect of farmers’ high medical expenses. But years of practice has proved that for some serious diseases, the guarantee of NCMS compensates the function is limited, participating farmers’ economic burden of disease is still relatively heavy. Some time happen such things as peasants who become poor and return to be poor because of illness.
In this context ,this paper bases on the overall social economic development in ShiYan City ,through the analysis of the background of severe disease insurance of the New Rural Cooperative System ,Based on comprehensive literature and practice ,clearly defines the concept of serious diseases、the property and targeting of severe disease insurance ,summarizes the development and problems of NCMS severe disease insurance in ShiYan City : Lacking of long-term financing mechanisms; low level guarantees, little range guarantees; farmers' impositive participation, etc. And we also make recommendations to improve the level of NCMS severe disease insurance of ShiYan City ,combined with the typical foreign countries and domestic severe disease insurance pilot experience ,for instance :Strengthening the top-level design ,Perfecting the security mechanism of severe disease insurance; Establishing a scientific ,reasonable and feasible financing mechanisms; reasonably controlling medical costs , improving the performance of fund guarantee; strengthening supervision ,Promoting the standard development of severe disease insuran..