中国城乡居民大病保险领域关键问题确认

高倩倩; 闫早红; 井淇; 蔡伟芹; 马安宁; 王培承; 盛红旗

doi:10.11847/zgggws1124751

中国城乡居民大病保险领域关键问题确认

Verification of key issues in critical illness insurance for urban and rural residents in China: a literature study

摘要

摘要:
目的明确大病保险运行过程中存在问题的重要性、严重性和优先解决性，确定优先解决的关键问题，为大病保险制度的进一步完善提供参考。
方法收集中国知网数据库2013年1月1日 — 2017年12月31日公开发表的关于中国城乡居民大病保险领域发展现状和问题的286篇文献，计算中国大病保险领域主要问题的重要性指数I_i、严重程度指数S_i和优先解决指数R_i，确认中国城乡居民大病保险领域的关键问题。
结果按组织管理、医保筹资、基金管理等医疗保险所属环节对286篇文献中涉及的关于中国城乡居民大病保险的问题进行归纳，发现大病保险领域的主要问题有39个，其中，“大病保险制度缺乏系统框架设计”（R_i = 0.078 1）、“资金的筹资水平低，不平衡，抗风险能力差”（R_i = 0.085 1）和“大病保险保障范围窄，大病保险的保障功能未能真正惠及最有需求的群体”（R_i = 0.050 9）是中国城乡居民大病保险领域的关键问题。
结论应从制度建设、资金筹集和保障范围等方面入手，妥善控制与解决中国城乡居民大病保险领域存在的关键问题。

Abstract:
Objective To identify important, serious and urgent problems to be solved in the implementation of critical illness insurance (CII) for urban and rural residents in China for the improvement of the insurance system.
Methods Via China National Knowledge Infrastructure (CNKI), We searched studies on CII for urban and rural residents in China published from January 2013 through December 2017. The indexes for the importance (I_i), severity (S_i), and priority (P_i) of all distinguished problems in the implementation of CII were calculated to identify the key issues.
Results Based on the summarization of 286 studies retrieved, 39 main problems were verified in the aspects of organization management, medical insurance financing, and fund management. Among the main problems in the implementation of CII, the three key issues were identified, including lack of framework design (R_i = 0.078 1), unbalanced low level and low anti-risk capital financing (R_i = 0.085 1), and narrow coverage unable to meet the requirement the people with the most demand (R_i = 0.050 9).
Conclusion System construction, fund raising and insurance coverage are the key issues should be properly managed in the implementation of critical illness insurance for urban and rural residents in China.

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