【作者】 陈涛；

【导师】 张再生；

【作者基本信息】 天津大学 ， 工商管理， 2010， 硕士

【摘要】 企业补充医疗保险作为我国城镇职工基本医疗保险的补充,是医疗保障体系的重要组成部分,随着人民生活水平的提高,职工健康需求不断增长,它在企业中的作用日益突出。建立和完善企业补充医疗保险,不仅能够保持职工原有医疗消费水平不降低、解决职工因病致贫问题,而且能够增强企业吸引力、推动企业和谐稳定发展。在国家鼓励和支持下,许多企业已经建立了企业补充医疗保险,但由于我国企业补充医疗保险市场不成熟,在具体实施中还存在着许多问题。国有大型企业是我国国民经济的支柱,XY公司作为典型的国有大型企业,对其企业补充医疗保险进行研究,具有重要的现实意义和借鉴作用。论文介绍了企业补充医疗保险的相关理论和政策,对XY公司企业补充医疗保险实施现状进行了系统分析,找出了XY公司在覆盖范围、基金筹集方式、大病患者及特困人群的医疗费用负担以及管理机构等方面存在的主要问题,在调查分析同类企业补充医疗保险实施情况的基础上,提出了完善XY公司企业补充医疗保险实施办法的具体思路和措施:一是严格遵守国家和地方政策,规范企业补充医疗保险实施范围,对于已列入而不应列入人员要予以清理并妥善处理,对于应列入而未列入人员要统筹安排逐步纳入;二是企业补充医疗保险基金筹集要与社会保险费征缴方式相一致,以提高工作效率和管理水平;三是在住院、慢性病和特殊病门诊个人负担医疗费正常补助的基础上,可对一般门(急)诊医疗费进行补助;四是提高特殊病病人、经济贫困人员、建国前参加革命工作的老工人以及劳动模范、企业优秀专家等特殊人员的补助标准,以充分发挥企业补充医疗保险的功能和作用;五是加强企业补充医疗保险的管理和监督,确保基金的安全和合法使用。企业补充医疗保险是一项集政策性、专业性和操作性为一体的系统工程,需要在国家和地方政策指导下,根据企业实际情况,不断地总结、调整和完善。论文完善企业补充医疗保险的具体实施方案,具有一定的针对性和操作性。更多还原

【Abstract】 Enterprise supplementary medical insurance for urban employees as a complement of the basic medical insurance is an important part of the health care system. With the improving of people’s living standard, the growing of employees’ health need, it has been an increasingly prominent role in enterprises. Establish and improve the enterprise supplementary medical insurance, not only keep the stability of the original level of the employee medical treatment consumes, solve the problem of poverty caused by illness, but also enhance the enterprise attraction and boost economic development with harmony and stability. With the encouragement and support of our country, many enterprises have established enterprise supplementary medical insurance, but as our country’s enterprise supplementary medical insurance market is not so mature, there are still many problems in the implementation. Large state-owned enterprises are the mainstay of the national economy, XY Enterprise, as one typical large state-owned enterprise, the study on enterprise supplementary medical insurance of it, possesses important realistic significance and reference value.This paper has introduced related theories and policies of enterprise supplementary medical insurance, made systemically analyze on the current status about enterprise supplementary medical insurance of XY Enterprise, found out the main problems in the cover rage, the ways of raising fund, the medical fund burden of serious illness patients and people who under poverty and the administration, etc. Based on the investigation and analysis on the implementation of enterprise supplementary medical insurance of other same kind enterprises, this paper has presented the details for thoughts and methods about how to perfection enterprise supplementary medical insurance of XY Enterprise: First, strictly abide by discipline of the country and the local government, make sure the practicing scope of enterprise supplementary medical insurance is criterion. Sort out and deal properly with those people who should not be in the list but already in it. Comprehensive arrangement and gradually bring in the people who should be in the list but not. Second, the way of enterprise supplementary medical insurance fund raising should be consistent with the social insurance premium collecting method to improve work efficiency and manage level. Third, on the base of normal personal afford medical treatment subsidies of personal afford medical treatment of be in hospital, chronic diseases and special diseases in the outpatient, it is allowed to give subsidies to the charge of primary medical treatment of door emergency. Fourth, raise the subsidy level of special disease patients, poverty-stricken people, people who work before 1949, model workers, enterprise’s best experts and other special people, to play the function and role of enterprise supplementary medical insurance. Firth, strengthen monitoring and management of enterprise supplementary medical insurance, make sure the fund safety and being used legally.Enterprise supplementary medical insurance is a system engineering of policy, professional and operability, which should be kept summing up, rectifying and consummating according to the actual conditions of the enterprise under the guidance of national and local policies. This paper has consummated the particular implementing schemes of enterprise supplementary medical insurance, and possesses certain pertinence and operability.更多还原