农村居民大病保险制度设计与运行中的问题及成因  

Problems and Causes Analysis About Rural Residents' Critical Illness Insurance System in Design and Operation Process

作　　者：张心洁[1] 周绿林[1] 刘畅[1] 

机构地区：[1]江苏大学管理学院,江苏镇江212013

出　　处：《西北农林科技大学学报（社会科学版）》2016年第5期8-14,共7页Journal of Northwest A&F University(Social Science Edition)

基　　金：国家社会科学基金项目(12BGL110);江苏省普通高校研究生科研创新计划项目(KYZZ_0290);江苏大学科研立项项目(13C366)

摘　　要：在梳理国内外大病保障研究现状及对江苏省农村居民大病保险制度实施情况进行实地调研和深入访谈的基础上,运用经典扎根理论自下而上挖掘并分析了大病保险制度设计和运行过程中存在的主要问题及其成因。研究认为,在制度、体制和管理等原因的影响下,农村居民大病保险制度在设计上存在概念属性和保障范围界定模糊、制度设计与实际保障范围差距明显等问题,在运行上则存在管理资源匮乏、商保机构优势尚未充分发挥等问题。建议农村居民大病保障制度应以大病保险制度为核心顺序推进,积极支持商保机构经办大病保险乃至新农合工作,为健全农村居民大病保障制度和完善全民医保体系提供支持。Based on the carding and analysis of the critical illness security research achievements at home and aboard,and conducting on-the-spot investigation and in-depth interview,this paper,using the classical grounded theory,analyzes the problems and reasons in the design and operation process of the critical illness insurance system.Under the influence of the system,mechanism and management reasons,this paper points out that some problems exist in the system design like concept or attribute defined fuzzy,obvious gap exists between system design and actual operation,at the same time,there are also some problems like lacking management resources in the system operation.Last but not the least,this paper puts forward some suggestions to perfect the critical illness insurance system and hopes to provide theoretical supports for perfecting the rural residents＇ critical illness insurance system and the universal health care system.

关 键 词：农村居民大病保险制度 新农合 商保机构 经典扎根理论 

分 类 号：F323.89[经济管理—产业经济]