商業(yè)保險(xiǎn)公司在承辦大病保險(xiǎn)中存在的問(wèn)題與對(duì)策
[Abstract]:With the further development of social productivity and the continuous improvement of people's living standard, social insurance plays an increasingly important role in national life. The serious illness insurance plays an extremely important role in social security, and the financial burden of the patients with the major diseases is greatly reduced through the reimbursement of the major diseases. In recent years, urban and rural residents' serious illness insurance is gradually entering the social security system through the market mechanism, and has achieved quite satisfactory results. At the same time, great progress has been made in the basic policies. Financing aspects, cost handling, settlement management, etc. However, in the process of practice, the serious illness insurance still faces various tests. There are many problems in the policies and regulations, the level of financing, the docking of the government and business system, the cooperation mode, the hidden price competition and so on. In addition, there are still some problems in the effective connection between public expenditure and commercial insurance companies, which is especially obvious in the connection between public finance payment and commercial insurance companies. Through solving these problems, this paper hopes to straighten out the core problems of the serious illness insurance business undertaken by commercial insurance companies. First of all, from the angle of view of commercial insurance company with operator status, this paper adopts literature analysis, comparative analysis and other research methods to understand several typical models. A clearer analysis of the real situation of commercial insurance companies in undertaking major illness insurance business activities. In this way, the problems existing in the process of undertaking the insurance of serious illness in China's commercial insurance companies are analyzed from three aspects: the imperfect policies and regulations, such as the imperfect laws and regulations, the phenomenon of government supervision misplacing and offside, which occur from time to time. The medical insurance policy lacks the overall design, the serious illness insurance fund waste phenomenon lacks the effective countermeasure, such as the hospital "excessive medical treatment", the supervision and management way is single, the medical information is not shared, the application level of "intelligent audit" needs to be strengthened. The medical insurance expenditure performance evaluation is insufficient, the medical insurance effect quantitative analysis is insufficient, the serious illness insurance characteristic, the mechanism, the standard exploration insufficiency, causes the serious illness medical treatment safeguard level to be low. Finally, some countermeasures and suggestions are put forward to solve the problems, not only from the government policy level, to meet the needs of multiple interests, but also to construct the overall legal framework scientifically, and to create new ideas to strengthen the supervision and assessment of the participants. Strengthen supervision of hospital "excessive medical treatment", popularize the use of "intelligent audit" information means, and introduce third party organizations to evaluate the effect of medical insurance; at the same time, with the promotion and in-depth study of the insurance for serious illness, we should comprehensively implement countermeasures. To improve the level of insurance for serious illness, to strengthen the analysis and research on the characteristics of the insurance of serious illness, to establish the working mechanism of the linkage between commercial insurance and social insurance, and to formulate a unified standard of insurance for serious illness.
【學(xué)位授予單位】:山西大學(xué)
【學(xué)位級(jí)別】:碩士
【學(xué)位授予年份】:2017
【分類(lèi)號(hào)】:F842.6
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