全民醫保論文：中國醫保一體化研究【中文摘要】健康權屬于每個公民,全體社會成員不應因社會地位、經濟收入、地域特征、性別和年齡等因素的不同而區別對待,每個社會成員都有權按照自身的經濟承受能力來選擇自己需要的醫療保障,這是醫療保險制度的機會均等問題。覆蓋全民的醫療保險制度是中國新醫改的目標。隨著城鄉一體化的發展和戶籍制度的改革,學者開始從政治角度和經濟角度討論全民醫保的必要性和可實現性。我國目前醫療保險市場存在著諸多問題,比如覆蓋面不廣、未能涵蓋弱勢群體、醫療保險籌資公平和服務利用不平衡等。其中,覆蓋范圍是最為突出的問題。本文基于機會均等理論和對全面醫保概念的界定,從機會均等的角度分析我國醫療保險制度缺乏平等性的現狀,用Probit模型分析了不同因素對我國醫療保險需求的影響并對實現全面醫保的實現途徑提出政策性建議。本文介紹了中國醫療保險制度形成的主要歷程和發展趨勢,通過歷史分析法縱向考察了我國城鄉醫療保險體制的變遷,并通過比較分析法描述了我國城鄉醫療保障服務公平性差異的基本事實。本文從底線公平角度提出實現全民醫保的必要性,并分析了目前其他國家實現全民醫保的成功典范,詮釋了全民醫保的概念和目前我國實現全民醫保的三種主要途徑。底線公平有三個層次的要求,其中第一個層級,即是機會公平,這是實現全民醫保的門檻和基本要求。文章實證部分以1989年到2009年至今CHNS所做的八次調查數據為依托,通過建立Probit模型,從個人特征,地區特征,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.【關鍵詞】全民醫保底線公平機會公平CHNSProbit模型【英文關鍵詞】UniversalCoverageEqualityofBaselineEqualityofopportunityCHNSProbitModel【目錄】中國醫保一體化研究

中文摘要

6-8

ABSTRACT

8-10

第一章引言

11-17

1.研究背景和選題的意義

11-12

2.文獻綜述

12-15

3.論文結構框架、創新點和不足

15-17

第二章中國醫保制度形成的主要歷程和發展趨勢

17-21

1.初期的醫療保險體系

17-18

2.改革探索時期的醫療保險體系

18-19

3.醫保制度的建設、完善時期和醫保改革的發展趨勢

19-21

第三章中國城鄉醫療保障服務公平性差異的基本事實

21-30

1.我國衛生費用城鄉分配的公平性

21-25

2.我國醫療保險籌資的公平性

25-27

3.我國醫療保險籌資使用狀況比較

27-30

第四章醫保一體化的本質