【作者】 张军；

【导师】 龚长宇；

【作者基本信息】 苏州大学 ， 公共管理（专业学位）， 2015， 硕士

【摘要】 城乡二元化的基本医疗保险制度,在制约着基本医疗保险制度公平性的同时,也影响着我国城市化的进程。完善基本医疗保险制度,构建城乡一体化医疗保障管理体系是时代发展的要求。我国现行的城镇职工基本医疗保险制度、城镇居民基本医疗保险制度、新型农村合作医疗制度三大医疗保险制度在待遇享受、制度衔接、转移接续等方面存在较大差距与困难。本文以社会公平理论和公共服务均等化理论作为理论基础,从城乡一体化、医疗保障管理、城乡医疗保障一体化等概念界定入手,对我国城乡医疗保障制度的变迁和管理体制的改革历程作了系统梳理;对城乡医疗保障一体化管理的必要性作了分析;以苏州市吴中区建立城乡医疗保障一体化管理模式为个案进行深入研究,阐述了该区城乡医疗保障一体化管理的现状,揭示了吴中区在实行城乡医疗保障一体化过程中所面临的医保经办体系多头化、城乡医保政策的差异性、医疗保险专业性人才缺乏、定点医疗机构违规操作、参保人员对医疗保险认识不足等多方面困境,并进行了原因分析,在此基础上从完善城乡医保一体化政策、整合城乡医保经办机构、提高城乡统筹层次、强化对定点医疗机构监管、完善科学管理的付费机制等方面提出合理化建议与对策。更多还原

【Abstract】 The basic medical insurance system for urban and rural dualistic, restricts the fairness of basic medical insurance system at the same time, also affects the process of urbanization in our country. Improve the basic medical insurance system, constructs the integration of urban and rural medical security management system is the requirement of era development. Current urban employee basic medical insurance system, basic medical insurance system for urban residents, the new rural cooperative medical care system three big system of medical insurance system in the treatment of enjoy, cohesion and transferring large gap with difficulty.In this paper, according to the theory of social justice and equal public service theory as the theoretical basis, from the urban and rural integration, the integration of urban and rural medical security, health care management such as definition, the changes of the urban and rural medical security system of our country and the reform of the management system of the course system combing; To analyses the necessity of the integration of urban and rural medical security management; In suzhou wuzhong district to set up the integration of urban and rural medical security management mode as a case study, this paper expounds the status quo of the integration of urban and rural medical security management, reveals the wuzhong district in the process of implement the integration of urban and rural medical security orgnaization of health-care system facing long of the differences between urban and rural health policy, medical insurance, lack of professional talents, the medical establishment that decide a dot irregularities and the shortage of medical insurance ginseng protect personnel to meet the various difficulties,and analyzed the reason, on this basis, from the perfect integration of urban and rural medical insurance policy, the integration of urban and rural medical insurance agency orgnaization, improve urban and rural overall level, strengthening the supervision on themedical establishment that decide a dot, improve the scientific management of the pay mechanism put forward rationalization proposals and countermeasures.更多还原