全民医保论文：中国医保一体化研究

全民医保论文：中国医保一体化研究【中文摘要】健康权属于每个公民,全体社会成员不应因社会地位、经济收入、地域特征、性别和年龄等因素的不同而区别对待,每个社会成员都有权按照自身的经济承受能力来选择自己需要的医疗保障,这是医疗保险制度的机会均等问题。覆盖全民的医疗保险制度是中国新医改的目标。随着城乡一体化的发展和户籍制度的改革,学者开始从政治角度和经济角度讨论全民医保的必要性和可实现性。我国目前医疗保险市场存在着诸多问题,比如覆盖面不广、未能涵盖弱势群体、医疗保险筹资公平和服务利用不平衡等。其中,覆盖范围是最为突出的问题。本文基于机会均等理论和对全面医保概念的界定,从机会均等的角度分析我国医疗保险制度缺乏平等性的现状,用Probit模型分析了不同因素对我国医疗保险需求的影响并对实现全面医保的实现途径提出政策性建议。本文介绍了中国医疗保险制度形成的主要历程和发展趋势,通过历史分析法纵向考察了我国城乡医疗保险体制的变迁,并通过比较分析法描述了我国城乡医疗保障服务公平性差异的基本事实。本文从底线公平角度提出实现全民医保的必要性,并分析了目前其他国家实现全民医保的成功典范,诠释了全民医保的概念和目前我国实现全民医保的三种主要途径。底线公平有三个层次的要求,其中第一个层级,即是机会公平,这是实现全民医保的门槛和基本要求。文章实证部分以1989年到2009年至今CHNS所做的八次调查数据为依托,通过建立Probit模型,从个人特征,地区特征,recommendationsaboutthepathforrealizeacomprehensivehealthinsuranceInmypaper,IdescribetheformationofChina’smedicalinsurancesystemandthedevelopmenttrendofthemaincourse,throughhistoricalanalysisofthechangesofurbanandruralmedicalinsurancesystembylongitudinalcomparison;describethebasicfactsofurbanandruraldifferencesinthefairnessofhealthcareservicesusingmethodofcomparativeanalysis.Thisarticleputsforwardthenecessityofuniversalhealthcarefromthepointofequalityofbaseline,andanalyzessomeexamplesofforeigncountrieswhohavealreadytoachieveasuccessfuluniversalhealthcare,definetheconceptofuniversalhealthcareandthreemainwaystoachieveuniversalcoveragecurrently.Therearethreelevelsofequalityofbaseline,thefirstlevel,namedequalopportunity,whichisthethresholdofuniversalhealthcareandbasicrequirements.Empiricalpartofthearticleusingdatefrom1989to2009,whichmadeeightCHNSsurveydataasthebasis,throughtheestablishmentofProbitmodel,frommanyfactorssuchasthepersonalcharacteristics,regionalcharacteristics,occupationalcharacteristicsandincome,analyzethemainfactorswhichmayaffectthebehaviorofinsuringmedicalinsurance,andthedistributionofthegroupofthemedicalinsuranceindifferentcharacteristics.TheempiricalresultsshowthatthereisaclearunfairnessinChina’shealthinsurancesystem.Participatingbehaviorismainlyaffectedbyage,gender,occupationalcharacteristicsandeducationallevels;participatingbehaviorisnotaffectedbythefactorofurbanandruralareas.Thereisatremendousparadoxabouttheconclusioncomparedtothepastliteratureswhichconsiderthatthehealthinsurancecoverageinruralandurbanareasexistsahugedifference.Totheextremeextent,thisisduetotheimplementationofNCMSandbecausethesurveydataisonlyconcernedaboutthecoverageofthemedicalinsurance,thedepthdifferenceoftheurbanandruralhealthcarecannotreflectinafairway.Yearsofeducationisthemostinfluentialfactorsaboutinvolvementofhealthinsurance,educationalfactorsrestrictaperson’semphasisonhealthinsuranceandpurchasingpowerfromdirectandindirectaspects,thearticleputsforwardssomepolicyrecommendationsforstrengtheningnationaleducationandsuggeststhathighlevelsofeducationbyimprovingtheoverallqualityofthepopulationcanpromotethehealthinsurancemarket.Finally,Iputforwardaboutthereformofthemedicalinsurancemarket.Basedonthethreenetworksofthebasicmedicalinsurancesystemforurbanemployees,basicmedicalinsurancesystemforurbanresidentsandthenewruralcooperativemedicalinsurancesystem,wecanrealizetheuniversalhealthcaresystemstepbystepthrough“threenetstotwonets”,andthen“twonetstoonenet”.Thisinnovationofmyarticleisthat:Inconsideringthefactorswhichimpacttheparticipationofhealthinsurance,thechoiceofpopulation,geography,occupation,incomeandotherdemographiccharacteristicsandeconomiccharacteristics,coincidewiththeresearchfieldofforeignperspective,andbasedonthepreviousstudies,Iaddtheprofessionalcharacteristicsastheinfluencingfactors,thisisinnovative;meanwhile,empiricalanalysisofdatacomesfromChinaHealthandNutritionSurvey(CHNS),samplevolumeishuge,andcomparedtodatagotfromthedomesticresearchersonfieldresearch,statisticaldatafromwebsites,thedatafromCHNSaremoredetailed.AndforeignresearchersinthestudyofChinaarewidespreadusingthisdatabase.Theselecteddataarefrom1989,through8survey,thelatestdataupdateto2009;duetoupdatesofdata2009wastoolatethatdomesticresearchersgenerallyselectthedatafromCHNSto2006.Thispaperusingthedataupdatedto2009,itcanbemorerepresentativeofthebasicsituationofthedomestic,andtheempiricalstudyaremoreconvincing.【关键词】全民医保底线公平机会公平CHNSProbit模型【英文关键词】UniversalCoverageEqualityofBaselineEqualityofopportunityCHNSProbitModel【目录】中国医保一体化研究

中文摘要

6-8

ABSTRACT

8-10

第一章引言

11-17

1.研究背景和选题的意义

11-12

2.文献综述

12-15

3.论文结构框架、创新点和不足

15-17

第二章中国医保制度形成的主要历程和发展趋势

17-21

1.初期的医疗保险体系

17-18

2.改革探索时期的医疗保险体系

18-19

3.医保制度的建设、完善时期和医保改革的发展趋势

19-21

第三章中国城乡医疗保障服务公平性差异的基本事实

21-30

1.我国卫生费用城乡分配的公平性

21-25

2.我国医疗保险筹资的公平性

25-27

3.我国医疗保险筹资使用状况比较

27-30

第四章医保一体化的本质