基于醫(yī)保基金風(fēng)險(xiǎn)防控的重慶市城鄉(xiāng)居民醫(yī)療保險(xiǎn)支付方式創(chuàng)新研究.pdf

1、 AnInnovative Research on the Cooperative Medical Insurance Payment for Urban and Rural Residents in Chongqing , Which Based on the Risk prevention and Control of Medical Insurance Fund A Thesis Submitted to Chongqing Un

2、iversity in Partial Fulfillment of the Requirement Professional Degree By Tang Fali Supervised by Prof. Luo Zhang Pluralistic Supervised by Wu Bangli Specialty: Master of Public Administration School of Public Affairs, C

3、hongqing University, Chongqing, China November 2017 重慶大學(xué)碩士學(xué)位論文 英文摘要 II ABSTRACT The third plenary session of the 18th CPC central committee proposed a more equitable and sustainable social security system, and required d

4、efinitly to integrate basic medical insurance system for urban and rural residents as soon as possible. To be one of the forerunners, Chongqing had integrated the New Rural Cooperative Medical System and the Medical Insu

5、eance for Urban Residents into the Cooperative Medical Insurance for Urban and Rural Residents in 2009, which indicated the framework of the basic medical insurance system that covers urban and rural residents has been f

6、ormed basically, and has been achieved the goal of medical insurance for all in the system. However, as the number of insured people grows, and the security level improves year by year, following a sharp rise in medical

7、costs and fund risk , causes a “ difficulty and expensive in seeing a doctor” situation to the insured, and increasing frequency of medical insurance funds deficit, how to control the increase of medical expenses and avo

8、id the risk of insurance fund become an important issue to be solved urgently. From the medicaremanagement aspects, to seek for a balance between ensuring medical service quality and controlling medical expenses, innovat

9、ive payment is an effective、imperative measure to insurance fund risk prevention and control. This paper takes medical insurance for urban and rural residents as the innovative studies, through contrast analyze, aims to

10、discuss the fund risk and causes under current medical insurance payment method theoretically,bases on the domestic and international advanced practical experience, combines with actual running of medical insurance for u

11、rban and rural residents system in Chongqing, explores a payment method which suits social economic development level and medicare management requirement of Chongqing, meanwhile, put forwards suggestions and countermeasu

12、res to innovate the medical insurance for urban and rural residents payment method. KeyWords: Cooperative Medical System and the Medical Insueance for Urban Residents, Payment, the risk of medical insurance fund, innova