全民醫(yī)保論文：中國醫(yī)保一體化研究

全民醫(yī)保論文：中國醫(yī)保一體化研究【中文摘要】健康權(quán)屬于每個(gè)公民,全體社會(huì)成員不應(yīng)因社會(huì)地位、經(jīng)濟(jì)收入、地域特征、性別和年齡等因素的不同而區(qū)別對(duì)待,每個(gè)社會(huì)成員都有權(quán)按照自身的經(jīng)濟(jì)承受能力來選擇自己需要的醫(yī)療保障,這是醫(yī)療保險(xiǎn)制度的機(jī)會(huì)均等問題。覆蓋全民的醫(yī)療保險(xiǎn)制度是中國新醫(yī)改的目標(biāo)。隨著城鄉(xiāng)一體化的發(fā)展和戶籍制度的改革,學(xué)者開始從政治角度和經(jīng)濟(jì)角度討論全民醫(yī)保的必要性和可實(shí)現(xiàn)性。我國目前醫(yī)療保險(xiǎn)市場(chǎng)存在著諸多問題,比如覆蓋面不廣、未能涵蓋弱勢(shì)群體、醫(yī)療保險(xiǎn)籌資公平和服務(wù)利用不平衡等。其中,覆蓋范圍是最為突出的問題。本文基于機(jī)會(huì)均等理論和對(duì)全面醫(yī)保概念的界定,從機(jī)會(huì)均等的角度分析我國醫(yī)療保險(xiǎn)制度缺乏平等性的現(xiàn)狀,用Probit模型分析了不同因素對(duì)我國醫(yī)療保險(xiǎn)需求的影響并對(duì)實(shí)現(xiàn)全面醫(yī)保的實(shí)現(xiàn)途徑提出政策性建議。本文介紹了中國醫(yī)療保險(xiǎn)制度形成的主要?dú)v程和發(fā)展趨勢(shì),通過歷史分析法縱向考察了我國城鄉(xiāng)醫(yī)療保險(xiǎn)體制的變遷,并通過比較分析法描述了我國城鄉(xiāng)醫(yī)療保障服務(wù)公平性差異的基本事實(shí)。本文從底線公平角度提出實(shí)現(xiàn)全民醫(yī)保的必要性,并分析了目前其他國家實(shí)現(xiàn)全民醫(yī)保的成功典范,詮釋了全民醫(yī)保的概念和目前我國實(shí)現(xiàn)全民醫(yī)保的三種主要途徑。底線公平有三個(gè)層次的要求,其中第一個(gè)層級(jí),即是機(jī)會(huì)公平,這是實(shí)現(xiàn)全民醫(yī)保的門檻和基本要求。文章實(shí)證部分以1989年到2009年至今CHNS所做的八次調(diào)查數(shù)據(jù)為依托,通過建立Probit模型,從個(gè)人特征,地區(qū)特征,recommendationsaboutthepathforrealizeacomprehensivehealthinsuranceInmypaper,IdescribetheformationofChina’smedicalinsurancesystemandthedevelopmenttrendofthemaincourse,throughhistoricalanalysisofthechangesofurbanandruralmedicalinsurancesystembylongitudinalcomparison;describethebasicfactsofurbanandruraldifferencesinthefairnessofhealthcareservicesusingmethodofcomparativeanalysis.Thisarticleputsforwardthenecessityofuniversalhealthcarefromthepointofequalityofbaseline,andanalyzessomeexamplesofforeigncountrieswhohavealreadytoachieveasuccessfuluniversalhealthcare,definetheconceptofuniversalhealthcareandthreemainwaystoachieveuniversalcoveragecurrently.Therearethreelevelsofequalityofbaseline,thefirstlevel,namedequalopportunity,whichisthethresholdofuniversalhealthcareandbasicrequirements.Empiricalpartofthearticleusingdatefrom1989to2009,whichmadeeightCHNSsurveydataasthebasis,throughtheestablishmentofProbitmodel,frommanyfactorssuchasthepersonalcharacteristics,regionalcharacteristics,occupationalcharacteristicsandincome,analyzethemainfactorswhichmayaffectthebehaviorofinsuringmedicalinsurance,andthedistributionofthegroupofthemedicalinsuranceindifferentcharacteristics.TheempiricalresultsshowthatthereisaclearunfairnessinChina’shealthinsurancesystem.Participatingbehaviorismainlyaffectedbyage,gender,occupationalcharacteristicsandeducationallevels;participatingbehaviorisnotaffectedbythefactorofurbanandruralareas.Thereisatremendousparadoxabouttheconclusioncomparedtothepastliteratureswhichconsiderthatthehealthinsurancecoverageinruralandurbanareasexistsahugedifference.Totheextremeextent,thisisduetotheimplementationofNCMSandbecausethesurveydataisonlyconcernedaboutthecoverageofthemedicalinsurance,thedepthdifferenceoftheurbanandruralhealthcarecannotreflectinafairway.Yearsofeducationisthemostinfluentialfactorsaboutinvolvementofhealthinsurance,educationalfactorsrestrictaperson’semphasisonhealthinsuranceandpurchasingpowerfromdirectandindirectaspects,thearticleputsforwardssomepolicyrecommendationsforstrengtheningnationaleducationandsuggeststhathighlevelsofeducationbyimprovingtheoverallqualityofthepopulationcanpromotethehealthinsurancemarket.Finally,Iputforwardaboutthereformofthemedicalinsurancemarket.Basedonthethreenetworksofthebasicmedicalinsurancesystemforurbanemployees,basicmedicalinsurancesystemforurbanresidentsandthenewruralcooperativemedicalinsurancesystem,wecanrealizetheuniversalhealthcaresystemstepbystepthrough“threenetstotwonets”,andthen“twonetstoonenet”.Thisinnovationofmyarticleisthat:Inconsideringthefactorswhichimpacttheparticipationofhealthinsurance,thechoiceofpopulation,geography,occupation,incomeandotherdemographiccharacteristicsandeconomiccharacteristics,coincidewiththeresearchfieldofforeignperspective,andbasedonthepreviousstudies,Iaddtheprofessionalcharacteristicsastheinfluencingfactors,thisisinnovative;meanwhile,empiricalanalysisofdatacomesfromChinaHealthandNutritionSurvey(CHNS),samplevolumeishuge,andcomparedtodatagotfromthedomesticresearchersonfieldresearch,statisticaldatafromwebsites,thedatafromCHNSaremoredetailed.AndforeignresearchersinthestudyofChinaarewidespreadusingthisdatabase.Theselecteddataarefrom1989,through8survey,thelatestdataupdateto2009;duetoupdatesofdata2009wastoolatethatdomesticresearchersgenerallyselectthedatafromCHNSto2006.Thispaperusingthedataupdatedto2009,itcanbemorerepresentativeofthebasicsituationofthedomestic,andtheempiricalstudyaremoreconvincing.【關(guān)鍵詞】全民醫(yī)保底線公平機(jī)會(huì)公平CHNSProbit模型【英文關(guān)鍵詞】UniversalCoverageEqualityofBaselineEqualityofopportunityCHNSProbitModel【目錄】中國醫(yī)保一體化研究

中文摘要

6-8

ABSTRACT

8-10

第一章引言

11-17

1.研究背景和選題的意義

11-12

2.文獻(xiàn)綜述

12-15

3.論文結(jié)構(gòu)框架、創(chuàng)新點(diǎn)和不足

15-17

第二章中國醫(yī)保制度形成的主要?dú)v程和發(fā)展趨勢(shì)

17-21

1.初期的醫(yī)療保險(xiǎn)體系

17-18

2.改革探索時(shí)期的醫(yī)療保險(xiǎn)體系

18-19

3.醫(yī)保制度的建設(shè)、完善時(shí)期和醫(yī)保改革的發(fā)展趨勢(shì)

19-21

第三章中國城鄉(xiāng)醫(yī)療保障服務(wù)公平性差異的基本事實(shí)

21-30

1.我國衛(wèi)生費(fèi)用城鄉(xiāng)分配的公平性

21-25

2.我國醫(yī)療保險(xiǎn)籌資的公平性

25-27

3.我國醫(yī)療保險(xiǎn)籌資使用狀況比較

27-30

第四章醫(yī)保一體化的本質(zhì)