【摘要】：近年來,重大疾病發(fā)病率逐年上升,醫(yī)療費用逐年增加,城鄉(xiāng)居民“因病致貧、因病返貧”的現(xiàn)象屢屢上演。為解決這一問題,國家于2012年8月建立了城鄉(xiāng)居民大病保險制度。大病保險制度實施四年多以來,有效減輕大病患者的個人醫(yī)療負(fù)擔(dān)。然而,大病保險能否實現(xiàn)長期可持續(xù)經(jīng)營是一個備受關(guān)注的問題,而可持續(xù)的核心便是大病保險基金的收支平衡。本文以城鄉(xiāng)居民大病保險基金的收入和支出作為研究對象,分析我國31個省、市、區(qū)的大病保險基金平衡現(xiàn)狀以及未來25年內(nèi)基金的可持續(xù)性,據(jù)此提出相應(yīng)的政策建議。首先,本文對大病保險的基本概念進行界定,介紹大病保險的相關(guān)理論。其次,分別對國內(nèi)外現(xiàn)有的大病保險籌資方式和補償方式進行分析。再次,基于我國的大病保險籌資方式和補償方式,構(gòu)建大病保險基金的籌資模型和費用補償模型,以此測算出當(dāng)前我國31個省、市、區(qū)的大病保險基金收支結(jié)余現(xiàn)狀。最后,基于籌資模型和費用補償模型,構(gòu)建大病保險基金的盈余過程模型并測算未來25年內(nèi)各個省、市、區(qū)的大病保險基金盈余情況,根據(jù)測算結(jié)果分析各地區(qū)大病保險基金收支的可持續(xù)性,而后對籌資比例和補償比例等指標(biāo)進行敏感性分析。通過對基金收支的測算,本文發(fā)現(xiàn)未來25年內(nèi)絕大多數(shù)省份將面臨大病保險基金收不抵支的問題,而這一問題可能導(dǎo)致多數(shù)省份的大病保險制度存在不可持續(xù)性。敏感性分析結(jié)果顯示籌資比例、補償比例以及合規(guī)住院費用比例會影響大病保險基金的收支狀況,本文據(jù)此提出構(gòu)建長效的籌資機制、建立合理的補償機制等政策建議。
[Abstract]:In recent years, the incidence of major diseases has increased year by year, medical costs have increased year by year. In order to solve this problem, the state established the urban and rural residents serious illness insurance system in August 2012. Since the implementation of the serious illness insurance system for more than four years, the personal medical burden of patients with severe illness has been effectively alleviated. However, whether the insurance of serious illness can realize long-term sustainable management is a question of great concern, and the core of sustainability is the balance of income and expenditure of the insurance fund for serious illness. Taking the income and expenditure of urban and rural residents' serious illness insurance fund as the research object, this paper analyzes the balance of the fund in 31 provinces, cities and districts and the sustainability of the fund in the next 25 years, and puts forward corresponding policy suggestions. First of all, this paper defines the basic concept of serious illness insurance, introduces the related theory of serious illness insurance. Secondly, this paper analyzes the existing financing and compensation methods of major illness insurance at home and abroad. Thirdly, based on the methods of raising funds and compensation for serious illness insurance in our country, this paper constructs the financing model and cost compensation model of serious illness insurance fund, and then calculates the current situation of the balance of income and expenditure of the serious illness insurance fund in 31 provinces, cities and regions of our country. Finally, based on the financing model and the cost compensation model, this paper constructs the surplus process model of the major illness insurance fund and measures the surplus situation of the major illness insurance fund in each province, city and district in the next 25 years. According to the calculated results, the sustainability of the income and expenditure of the major illness insurance fund in various regions is analyzed, and then the sensitivity analysis of the financing ratio and the compensation ratio is carried out. Based on the calculation of fund income and expenditure, this paper finds that most of the provinces will face the problem of whether or not the income of the insurance fund will not be offset in the next 25 years, and this problem may lead to the unsustainable of the major illness insurance system in most provinces. The results of sensitivity analysis show that the proportion of financing, the proportion of compensation and the proportion of hospital expenses in compliance will affect the income and expenditure of the insurance fund for serious illness. Based on this, this paper puts forward some policy suggestions such as constructing a long-term financing mechanism and establishing a reasonable compensation mechanism.
【學(xué)位授予單位】：華僑大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1;F842.684

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