农村居民大病保险制度设计与运行中的问题及成因

摘要

Based on the carding and analysis of the critical illness security research achievements at home and a-board,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 sys-tem.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 de-sign 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 in-surance system and hopes to provide theoretical supports for perfecting the rural residents’critical illness insurance system and the universal health care system.%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。