【作者】 杨峰；

【导师】 李士雪； 王健；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2006， 硕士

【摘要】 为了适应社会主义市场经济的发展，建立和完善社会保障制度，从1994年底开始，我国进行城镇职工医疗保险的综合改革试点；从1998年开始，我国全面建设城镇职工医疗保险制度；截止2005年底，全国绝大部分地区组织实施了基本医疗保险，参保人数达到13700万人。 我国目前实施的城镇职工基本医疗保险制度是借鉴新加坡个人保健储蓄计划基础上建立起来的，是一种个人账户与社会统筹相结合的职工医疗保险的基金运行模式。个人账户主要支付药店、门诊的医疗保险费用，统筹基金主要支付住院的医疗保险费用。 城镇职工基本医疗保险实施以来，针对个人帐户的运行问题已经做了很多的探讨。如：加大基金的筹资力度，加强个人帐户的积累；界定适宜的基本医疗保险范围，确定相应的个人帐户划入比例；加强个人帐户的使用和管理。本研究欲通过分析个人帐户门诊和药店利用、费用的情况，研究个人帐户利用的影响因素。并通过查阅二手资料，对个人帐户利用做进一步研究。 根据研究设计，本研究一方面采用等距抽样，从调查市2002-2003年城镇职工基本医疗保险统计数据库抽取参保人员作为研究对象，抽样内容包括参保人员基本信息及其个人帐户情况，另一方面通过查阅二手资料，获取相关内容。本研究采用的统计分析方法主要有：方差分析、秩和检验、最优尺度回归分析、多元线性回归分析。 本研究主要结果：1)个人帐户支出占参保人员药店、门诊的医疗保险费用的82.6％，其中，药品费用占个人帐户支出的85.6％。从参保人员个人帐户利用的总次数、年人均次数方面可以看出，药店购药服务利用均高于门诊就诊服务利用，调查市参保人员年人均门诊次数高于全国一般水平；从参保人员总费用、次均费用方面可以看出，药店购药总费用高于门诊就诊总费用，次均门诊费用高于次均药店购药费用，调查市参保人员次均门诊费用低于全国一般水平。2)就筹资而言，个人帐户基金结余的比例在逐年下降，更多还原

【Abstract】 For adapting to the development of socialism market economy, building and perfecting social security system, our government began to carry out piloting for basic medical insurance ( BMI) reform at the end of 1994. From 1998, began to establish BMI for urban employees entirely. By the end of 2005, a majority of regions have carried out BMI for urban employees, the number of insurants reached to 13.7 thousands.BMI for urban employees carried out now refers to individual Medisave in Singapore. It adopts to the mode combining medical saving account (MSA) and social pooling account (SPA). MSA is mainly used for the medical insurance cost of drugstore and outpatient, SPA is mainly used for the medical insurance cost of inpatient.From the beginning of BMI for urban employees, many discusses have been done about MSA. Such as, enhancing raising fund, and increasing accumulation of MSA, regulating appropriate BMI bound and confirming appropriate proportion of MSA, strengthening management and use of MSA.This study intends to research influential factors of MSA by analyzing the utilization and cost of drugstore and outpatient,and have a more research by refering to secondhand data.According to the project design, we sampled insurants from the 2002-2003 BMI for urban employees statistical database of surveyed city, including instance of insurant and MSA. Meanwhile, we acquired interrelated content by refering to secondhand data. The main analysis methods are: analysis of variance, ranks test, optimal scaling regression and multiple regression.Main founding of this study include: (1) The proportion of MSA in the medical insurance cost of drugstore and outpatient is 82.6%, the proportion of drug cost in MSA is 85.6%. Looking from MSA utilization on total time and average outpatient service time per更多还原