It has been over 10 years from the experiments in Zhenjiang and Jiujiang of the social health insurance of Chinese city employees till now. This policy has been great improved since it been set up and has revealed good effects. But still there are lots of system problems, include macroscopical problems in the medical service system and social health insurance system. They restrict the policy implement all-around, affect the medical service demand of the people and contravene with the equity of the medical service. we explain a new reimbursement system hierarchical reimbursement, based on some to find a essential way to solve the exist problems. And we make some analyses of need and feasibility of the system to improve its availability. The author table a proposal of some keys to solve the problems after analyzing some most important ones. Based on some analyses of the medical service market, we can take the conclusion that the hierarchical reimbursement can make the market competition more equitable to the patient, and so prove the need of the reimbursement system. We take three aspects to improve the feasibility of the system. First we set an academic model of the medical insurance demand, which can prove the hierarchical reimbursement is coincidental with insurance theory. Second we present the insurance systems of some developed countries in order to prove the hierarchical reimbursement is feasible in practice. And last we make a survey to describe how much people accept the new policy, the result is positive. After the three analyses above, we can get the conclusion that the hierarchical reimbursement is the certain demand of the medical insurance under the nowadays situation in China. At end of the theory, we notice that the hierarchical reimbursement can' t solve these problems well enough without other policy' s help. So we must enhance some other methods in order to cooperate with the hierarchical reimbursement to get the best benefit. Keyword: health insurance, hierarchical reimbursement, city staff

摘要: 澳门大学博(硕)士学位论文 我國的城鎮職工醫療保險制度改革從試點到現在的全面實施已經走過了 10 幾個年頭,成就是非常顯著的,同時問題也是比較嚴重的。這些問題中,包括有 我國的衛生服務系統方面和醫保體制方面的宏觀問題,也有醫療服務市場內部的 具體問題。他們的存在制約著醫保制度的全面推行,影響著參保人員的就醫需 求,違背了衛生服務的公平性原則。 本文以解決問題為目的,提出將分級報銷的思想引入醫療保險的支付行為 中,並且對其必要性和可行性進行了論證。 作者通過對現存的醫療服務市場中一些重點的問題的分析,提出了解決這些 問題的關鍵,通過對有分級報銷制度介入後醫療服務市場的分析,闡述了分級報 銷制度在解決這些問題中所起到的作用,從而論證了分級報銷制度引入的必要 性。 在可行性方面,作者從三個角度分析分級報銷制度的可行性。通過設立保險 需求理論模型,從理論上說明了分級報銷制度思想是符合保險學精神的;通過對 國際上一些發達國家的保險制度介紹,闡述了分級報銷制度在實踐上的可行性; 通過問卷調查的方法,說明了分級報銷制度的群眾接收性。從而得出分級報銷制 度在中國現階段的國情下是醫療市場內在的必然需求。 最後,分級報銷制度做為醫保制度的重要完善和補充,它的實施也是需要醫 療服務系統中其他相關措施相輔助的。只有各個方面均加以改善,分級報銷制度 才能發揮出其最大的優勢和作用。 關鍵字: 醫療保險, 分級報銷,城鎮職工