【作者】 李学军；

【导师】 温小霓；

【作者基本信息】 西安电子科技大学 ， 企业管理， 2005， 硕士

【摘要】 医疗保险作为整个社会保障系统的一部分,在保障全体劳动者的健康方面发挥了主要作用。而在医疗保险系统内部,各国政府又采用的不同形式的社会医疗保险,成为缓解社会矛盾,保护劳动力持续发展的重要手段。本研究是在中国城镇职工医疗保险改革实施进程中。针对社会医疗保险风险,医疗保险支付和覆盖面进行的定量研究。本文首先从概念上阐述了医疗保险的定义,然后对社会医疗保险的几种支付形式进行了介绍。而后,采用数学建模和计算机仿真的方法解决了在区域内现有社会医疗保险基金水平下提供最大水平医疗保障的问题,以期为提高医疗保险管理机构的科学决策和风险管理水平提供一个定量的科学合理的理论模型。本文的研究主要内容和结果如下: 现阶段社会医疗保险强调“低水平,广覆盖”,然而,在收入水平不高,医疗费用高涨的今天,重大疾病给人们带来的损失是难以承受的,因此,社会医疗保险需要扩大医疗保险的重大疾病的覆盖面,以此来减少参保人员的经济损失,达到社会共济,分散风险的目的。本文在对社会医疗保险支付系统深入分析研究的基础上,通过建立模型,和数据仿真实验对该问题做了试探性的研究,得到的结果显示,在保持现有相对固定的医疗保险金收入下可以为广大参保人员提供重大疾病的保障比例为0.29,即对重大疾病可以保障其住院费用的29%。希望所做的研究能为社会医疗保险的风险管理水平提供理论依据和科学基础,同时有利于提高医疗保险管理机构的科学决策与管理水平,更多还原

【Abstract】 As part of social security system, medical insurance plays an important role in ensuring the health of whole labor in our country. Different government adopts different forms to construct their medical insurance system. Medical insurance is one of the key methods to reconcile social conflicts and maintain the continuous development of labor. The paper, under the frame of China Medical Insurance Reform, presents the qualitative research on the Medical Insurance payment and covering range. Firstly, the paper explains the concept of medical insurance; Secondly, some different forms of payment in medical insurance are put forward; At last, the author solves the problem of maximum to medical insurance range under the current level of medical insurance fund, which provides a reasonable theoretic model for decision in medical insurance management. The result of research is as follows: “Low level and broad cover range”is the emphasis of current social medical insurance. However, the cost caused by the tremendous disease is unaffordable under the condition that medical cost is very high while the income level is low. Therefore, it is necessary for social medical insurance to broaden covering range for the tremendous diseases to reduce the economic loss and diverse the risks. The research does some experimental work through building some models based on the analysis of the payment system of social medical insurance. The result of computer simulation shows that 29% of fee of tremendous disease can be insured under the current level of medical insurance fee income. It is hoped that the research can provide some theoretical and scientific basis to the risk management of social medical insurance.更多还原