我国城镇医疗保险与医疗卫生费用控制研究

【作者】 燕安；

【导师】 李野；

【作者基本信息】 沈阳药科大学 ， 企业管理， 2005， 硕士

【摘要】 以人为本的可持续发展的观念深入人心。发展的终极目标是提高人们的生活质量，丰富人们的物质和文化生活。健康关系到每一个人的切身利益，成为全社会共同关注的话题。与健康密切相关的医疗保险等问题受到各国政府的高度重视。本文运用经济学理论从微观和宏观两个层面对医疗服务与医疗保险进行分析，阐述医疗服务与医疗保险的特点。对我国医疗卫生历史数据进行研究，显示出国家的卫生投入不足，这种趋势不利于卫生费用控制；同时在费用分配上存在明显的城乡差别。报告了我国医疗保险体制改革的现状，介绍英美等国的有益经验，提出对医疗保险体制改革和医疗费用控制的建议，并单独对药品费用控制进行讨论。本文主要结论是：微观层面，医疗服务与保险市场“道德风险”问题的存在，为医疗服务费用的需求与供给方共同分担提供了理论依据。宏观层面，把医疗保障体系划分为三个层次——公共卫生服务体系，社会医疗保险体系和商业医疗保险体系，这种划分为医疗保险改革和医疗费用控制构建了讨论框架。提出了我国医疗保险改革原则是“公平与效率并重”，发展方向是建立起多层次的医疗保障体系。加强对医疗服务提供方的费用控制，改革医疗机构的不合理补偿机制，并进行纵向一体化合作尝试。本文还就药品费用过快增长及药价虚高问题提出了解决思路。更多还原

【Abstract】 In modern time, the continuance development of "people-centred" conception has been accepted by most people. The ultimate target of development is to upgrade the people’s living condition both in material and spiritual aspects. Health condition is related to everybody of our human beings. The topic of the health has become the headline of our society. Almost all governments in the world have placed great emphasis on health insurance. The paper discussed health care and health insurance with the methods of microeconomics and macroeconomics. The special characters of these fields have been concerned. The paper researched the published statistics and data of China, which shown that the proportion of the government has been steadily decreased year by year in the health expenditure, and personal expenditure has increased greatly in recent years, which means that the health expenditure of the government has shrunk and such a situation weakened the health cost control. Meanwhile, there is great unfairness between rural and urban health consumption. The paper reviewed the process of health insurance reform in China, summarized the main achievements and existent problems in it, introduced some valuable experiences from other countries, gave some advices on health insurance reform in China, and discussed the control of pharmaceutical costs.The major synopsis and results were summarized as the following: The existence of "moral hazard" in health service and health insurance markets has caused the demand side and supply side share of health expenditures. Health security system can be divided into three parts— common health services, social health insurance and private health insurance. This division facilitated the discussion of the topic. The basic rule of health care and health insurance reform is "well-balanced integration of efficient economic development and social fairness"; the direction is to build up multilayer health security system. Government should input more account in common health service and medical aids. Social health insurance should extend its coverage, and county mutual health insurance must be developed, which should give more supports from government. It is suggested that we should build up community health care system, develop private health insurance markets, and increase the people’s awareness of the health. It is recommended that we must locate on "supply side cost sharing" system, reform health service cost compensates mechanism; carry out vertical integration between health service sector and更多还原