大病保险补偿模式的思考——基于天津市城乡居民住院数据的实证分析  

The Interpretation and Analysis of the Compensation Patterns for Major Illness Medical Insurance Policies——An Empirical Study Based on the Hospitalization Data of Residents in Tianjin

作　　者：朱铭来[1] 宋占军[1] 王歆[1] 

机构地区：[1]南开大学经济学院,天津300071

出　　处：《保险研究》2013年第1期97-105,共9页Insurance Studies

基　　金：中央高校基本科研业务费专项资金资助项目(编号NKZXB10041)资助

摘　　要：2012年8月,国务院六部委共同发布《关于开展城乡居民大病保险工作的指导意见》,目前各地政府正在积极筹划大病保险制度的具体实施方案。本文以指导意见中关于大病保险补偿模式的规定为切入点,基于天津市城乡居民住院医疗费用数据,从起付线、报销比例、封顶线等方面模拟分析不同补偿模式设计对于减轻人民群众大病医疗负担的作用和对医保基金支付能力的影响,以期为我国各地区制定和完善大病保险政策提供一定的参考价值,并促进我国大病保险制度的长期稳健、可持续发展。In August 2012,six ministries of the Central Government of China issued ＂The Guidance on the Major Illness Medical Insurance for Residents both in Rural and Urban Areas＂. Currently, many local governments are working on the design of detailed plans to implement the major illness medical insurance policies. In this paper, u- sing the hospitalization data of residents in Tianjin, we simulated different deductibles, reimbursement ratio and up- per-limits to analyze the effect of different compensation patterns on the out-of-pocket burden of residents and the fi- nancial pressure of the basic medical insurance fund. We hoped that our findings could provide some suggestions to the policymakers of local governments and make the major illness medical insurance system more steady and sus- tainable.

关 键 词：大病保险 补偿模式 保障水平 基金平衡 

分 类 号：F840.61[经济管理—保险]