【作者】 王杨；

【导师】 阳义南；

【作者基本信息】 华南理工大学 ， 公共管理（专业学位）， 2020， 硕士

【副题名】以A市为例

【摘要】 目前我国已经形成基本覆盖全国城乡居民的基本医疗保障体系,但是医疗费用的攀升;人口老龄化的加剧;更多重、恶性病的发现使许多家庭“因病致贫,因病返贫”。为了进一步支持基本医疗保险,完善我国社会医疗保险体系,大病保险应运而生。从2012年六部委发布《指导意见》开启大病保险在全国范围内的试点开始,这种由政府主导,专业运作的公共服务提供形式获得了明显成效。大病保险制度不仅协助完成新型政府职能的转变,更重要的是补充了基本医保的不足,为更加普惠、公平、健全的社会医保体系助力。但随着政策的推进,问题也逐渐凸显,关键问题的分析和解决将促使大病保险更加行之有效的实行。本文选取地处广东省粤东地区的A市为研究案例。首先运用文献研究法从大病保险概念及相关理论依据出发,简述我国医疗保险的发展历史以及大病保险经典模式,通过问卷调查和实地访谈的形式研究A市大病保险的实施现状。受访者普遍肯定大病医保的作用,但问题仍存在,可总结为:保险保障不足;基金缺乏稳定性;宣传、监度、信息共享系统缺失;险企未充分发挥作用。针对问题形成的原因论文主要通过A市大病保险政策制定层面和保险政策运行层面分别总结要点解析。第五部分通过对比分析法简述其他国家和地区医疗保险的优势和对A市的借鉴意义。在A市的具体境况及国际经验的基础上,论文的第六部分提出了合理化建议,包括完善保险政策的制定,明确政府定位和职责,激发保险公司的能效、信息共享和监督体制的健全等,以期对日后A市大病保险制度之完善尽绵薄之力。更多还原

【Abstract】 At present,China has formed a basic medical security system that basically covers the country.However,the rise of medical costs,the intensification of the aging of the population,and the discovery of more serious and malignant diseases make many families "become poor due to illness and return to poverty because of illness".In order to further support the basic medical insurance and improve the social medical insurance system of our country,serious illness insurance arises at the historic moment.Since the "guidance" issued by six ministries and commissions in 2012 to start the pilot project of serious illness insurance across the country,the government-led and professionally operated form of public service delivery has achieved remarkable results.The serious illness insurance system not only helps to complete the transformation of the new government functions,more importantly,it supplements the deficiency of the basic medical insurance,and contributes to a more universal,fair and sound social medical insurance system.However,with the promotion of the policy,the problem is becoming more and more prominent,and the analysis and solution of the key problems will promote the implementation of serious illness insurance more effectively.This paper selects A City,which is located in the eastern part of Guangdong Province,as a case study.First of all,using the method of literature research,starting from the concept and related theoretical basis of serious illness insurance,this paper briefly describes the development history of China’s medical insurance and the classical model of serious illness insurance,and studies the current situation of the implementation of serious illness insurance in A city in the form of questionnaire survey and on-the-spot interview.Respondents generally affirmed the role of serious illness health insurance,but there are still problems,which can be summarized as follows: insufficient insurance protection;lack of stability of the fund;lack of publicity to the general public.Non-existent supervision and information sharing system;insurance companies do not give full play to their expertise.The paper mainly summarizes and analyzes the main points through the formulation level of serious illness insurance policy and the operation level of insurance policy in A city.The fifth part briefly describes the advantages of medical insurance in other countries and the reference significance to A city through comparative analysis.On the basis of the specific situation of city A and other experience around the world,the sixth part of the paper puts forward some reasonable suggestions,including perfecting the formulation of insurance policy,defining the orientation and responsibility of the government,stimulating the energy efficiency of insurance companies,the sharing of information and the perfection of supervision system,in order to make a modest contribution to the improvement of the insurance system of serious illness in A city in the future.更多还原