城镇低收入群体医疗保障管理问题的研究
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摘要
医疗保障体系建设是近年来社会关注的焦点。十七大报告将医疗作为六大民生问题之一,明确提出了到2020年要建立一个“人人享有基本医疗卫生服务制度”的目标。而建立和完善医疗保障体系是实现这一目标的基础。目前,我国医疗保障体系的框架已基本形成,包括:城镇职工基本医疗保险制度、城镇居民基本医疗保险制度、新型农村合作医疗制度、其他特殊人群医疗保障和医疗救助制度等。
在城镇,我国最早建立的是城镇职工医疗保险制度,并且作为主体医疗保障制度至今。目前,它主要是以员工的单位作为参保单元,且缴纳保险费与医疗保障待遇相联系[1]。但对于低收入群体,特别是“三无对象”、企业下岗职工、特困职工及其家属,以及低保户等,其中的绝大数人没有资格或能力参加城镇职工医疗保险,更无能力参加商业医疗保险,且由于缺乏必要的公共健康保障制度,极大地限制了低收入人群对健康服务的可及性。
目前,对于城镇低收入人群中的低保户实行的是医疗救助的医疗保障办法,但对未纳入城镇低保范围且家庭人均收入接近低保边缘的低收入居民即所谓“低保边缘户”,则没有任何医疗保障措施。随着国家城镇居民基本医疗保险制度的逐步实施,低保户居民在享受城镇居民基本医疗保险待遇后,如何给予进一步的医疗保障,各地或多或少都有不同作法,但没有统一的标准和统一的执行机构而对“低保边缘户”则没有进一步的补偿。今年3月,民政部公布的城镇低保人数为2284万人,再加上相当数量的低保边缘居民,这部分低收入群体的医疗保障问题也越来越突出。从社会政治经济发展的角度来看,城镇城镇低收入群体的医疗保障管理问题解决不好,难以保证低收入人群的生活健康,将会严重影响小康社会的全面实现,也不利于促进社会的和谐稳定[2]。
为此,本课题试图通过对上海、洛阳和克拉玛依三个大、中、小,东、中、西比较有代表意义城市的低收入群体医疗保障管理现状的调查研究,分析问题,找出包括政府责任、就医办法、补偿支付等在内的管理对策,提出建立城镇低收入群体医疗保障的基本思路,整合现有资源,改变目前医疗救助方式,从制度和操作层面上逐步解决城镇低收入群体医疗保障问题。
In recent years, the construct of the Medical security system is one of the top focus of the society. According to The Report of the Party's 17th Major Concern, which treat the medical problem as one of the six main people's livelihood problem, and its clearly pointed out that a Basic medical and health service system in which everyone can enjoy will be build before 2020. To build a medical security system is the basic conditions to realize this goal. At present , the frame work of the medical security system has been formed , including Urban employee’Basic medical insurance system、Urban residents’basic medical insurance system、New Rural Cooperative Medical System、Other special groups’medical security system、Social medical aid system.
In the urban areas, urban employee medical insurance system was been founded firstly and was the main medical insurance till now. This system serve for urban workers only, and the treatment you enjoy was relation to the premium you pay. But the low-income groups, mainly the "three-no people"、laid-off workers、the extremely poor workers and their dependents、and the eligible recipients, most of them are not qualified to participate in the current medical insurance system, not to mention the ability to join the commerce medical insurance, but due to economic poverty, lack of necessary health protection system and the rising medical costs, making low-income groups mostly give up the necessary health services ,and greatly limited the health services to them.
Till now,we use medical security system to protect the eligible recipients in low-income guoup,but to the people whose income approach the low-income group,there is no medical security measure.As the state’s Urban residents’basic medical insurance system is being gradually implemented, how to give the eligible recipients of the low-income group further medical security after they enjoyed the basic medical assurance, different place have different treatments,and there is neither coherent standard nor coherent implement agency. In this March, the total amount of the low–income people is 22.84 million, plus the edge of the low-income residents, their medical security problem became more and more serious. By the view of the social and political development, if the medical security management problems can not be solved well, we can not security the healthy of the low-income group, and will serious influence the realize of the affluent society, as well as the to promote the harmonious society.
This paper is trying to analysis the urban residents’situation in the three cities: Shanghai、Luoyang and Karamay, in order to find the manage methods of the governmental responsibility、medical treatment approach、Compensation paid and so on.
在城镇,我国最早建立的是城镇职工医疗保险制度,并且作为主体医疗保障制度至今。目前,它主要是以员工的单位作为参保单元,且缴纳保险费与医疗保障待遇相联系[1]。但对于低收入群体,特别是“三无对象”、企业下岗职工、特困职工及其家属,以及低保户等,其中的绝大数人没有资格或能力参加城镇职工医疗保险,更无能力参加商业医疗保险,且由于缺乏必要的公共健康保障制度,极大地限制了低收入人群对健康服务的可及性。
目前,对于城镇低收入人群中的低保户实行的是医疗救助的医疗保障办法,但对未纳入城镇低保范围且家庭人均收入接近低保边缘的低收入居民即所谓“低保边缘户”,则没有任何医疗保障措施。随着国家城镇居民基本医疗保险制度的逐步实施,低保户居民在享受城镇居民基本医疗保险待遇后,如何给予进一步的医疗保障,各地或多或少都有不同作法,但没有统一的标准和统一的执行机构而对“低保边缘户”则没有进一步的补偿。今年3月,民政部公布的城镇低保人数为2284万人,再加上相当数量的低保边缘居民,这部分低收入群体的医疗保障问题也越来越突出。从社会政治经济发展的角度来看,城镇城镇低收入群体的医疗保障管理问题解决不好,难以保证低收入人群的生活健康,将会严重影响小康社会的全面实现,也不利于促进社会的和谐稳定[2]。
为此,本课题试图通过对上海、洛阳和克拉玛依三个大、中、小,东、中、西比较有代表意义城市的低收入群体医疗保障管理现状的调查研究,分析问题,找出包括政府责任、就医办法、补偿支付等在内的管理对策,提出建立城镇低收入群体医疗保障的基本思路,整合现有资源,改变目前医疗救助方式,从制度和操作层面上逐步解决城镇低收入群体医疗保障问题。
In recent years, the construct of the Medical security system is one of the top focus of the society. According to The Report of the Party's 17th Major Concern, which treat the medical problem as one of the six main people's livelihood problem, and its clearly pointed out that a Basic medical and health service system in which everyone can enjoy will be build before 2020. To build a medical security system is the basic conditions to realize this goal. At present , the frame work of the medical security system has been formed , including Urban employee’Basic medical insurance system、Urban residents’basic medical insurance system、New Rural Cooperative Medical System、Other special groups’medical security system、Social medical aid system.
In the urban areas, urban employee medical insurance system was been founded firstly and was the main medical insurance till now. This system serve for urban workers only, and the treatment you enjoy was relation to the premium you pay. But the low-income groups, mainly the "three-no people"、laid-off workers、the extremely poor workers and their dependents、and the eligible recipients, most of them are not qualified to participate in the current medical insurance system, not to mention the ability to join the commerce medical insurance, but due to economic poverty, lack of necessary health protection system and the rising medical costs, making low-income groups mostly give up the necessary health services ,and greatly limited the health services to them.
Till now,we use medical security system to protect the eligible recipients in low-income guoup,but to the people whose income approach the low-income group,there is no medical security measure.As the state’s Urban residents’basic medical insurance system is being gradually implemented, how to give the eligible recipients of the low-income group further medical security after they enjoyed the basic medical assurance, different place have different treatments,and there is neither coherent standard nor coherent implement agency. In this March, the total amount of the low–income people is 22.84 million, plus the edge of the low-income residents, their medical security problem became more and more serious. By the view of the social and political development, if the medical security management problems can not be solved well, we can not security the healthy of the low-income group, and will serious influence the realize of the affluent society, as well as the to promote the harmonious society.
This paper is trying to analysis the urban residents’situation in the three cities: Shanghai、Luoyang and Karamay, in order to find the manage methods of the governmental responsibility、medical treatment approach、Compensation paid and so on.
引文
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