近年来随着经济水平的增长，医疗水平的提升以及人们健康意识的增强等原因，城乡居民对于看病的需求以及相应的医疗保障的需求也日益增强。目前我国已经基本实现基本医疗保险的全覆盖，但是因基本医疗保险本身低水平的保障特点，已经越来越不能满足人们的需求，在此基础上，城乡居民大病保险制度应运而生，作为城乡基本医疗保险制度的补充。
    自2012年，国家出台城乡居民大病保险的相应政策以来，各地政策也是相继而出。随着政策的运行和发展，问题也随之涌现。城乡居民大病保险制度对于缓解城乡居民看病负担起着重要作用，对于城乡居民大病保险制度运行存在的问题亟需解决。
本文选择城乡居民大病保险制度运行中存在的问题及对策研究作为课题研究，以北京市房山区为例，研究城乡居民大病政策执行的进展情况，基于梅兹曼尼和萨巴蒂尔综合模型理论视角，通过文献研究法、访谈法、案例分析法的研究方法，从政策本身和政策以外的变量两个方面选择可能会影响城乡居民大病保险政策执行的因素，以期在此基础上提出有针对性地建议。
首先，是对城乡居民保险大病制度的制度架构进行介绍，其次，通过在对房山区城乡居民大病保险工作相关数据以及对房山区城乡居民大病保险12名经办人员和28名城乡居民参保人的一对一访谈和案例分析的基础上，总结出房山区城乡居民大病保险运行中主要存在以下问题：多部门联动不足导致报销周期过长、基金支出压力大、补偿方案设置存在争议、监督管理缺乏、政策知晓度不高。通过访谈的结果，结合梅兹曼尼和萨巴蒂尔综合模型，分析影响政策执行的影响因素和原因。政策本身的因素有筹资机制不够健全、补偿制度有待完善、报销流程机制不合理；政策本身以外的因素有政策执行人员效率低、缺乏严格有力的监管机制、政策的宣传力度不足、技术环境有待提高。在此基础上，结合房山区实际情况并借鉴北京市其他区县工作中的经验，对优化房山区城乡居民大病保险工作提出针对性对策：完善筹资机制和报销流程机制，建立科学的大病补偿机制，提升经办人员工作效率，加强政策宣传、提高技术环境，完善监管机制。

In recent years, with the growth of the economic level, the improvement of the medical level and the enhancement of people's health awareness, the demand of urban and rural residents for medical treatment and the corresponding medical security has also increased. At present, China has basically achieved full coverage of basic medical insurance, but due to the low level of protection characteristics of basic medical insurance, it has been increasingly unable to meet people's needs, on this basis, the serious illness insurance system for urban and rural residents came into being, as a supplement to the urban and rural basic medical insurance system.
Since 2012, when the state introduced the corresponding policies for serious illness insurance for urban and rural residents, local policies have also been issued one after another. As the policy runs and develops, so do the problems. The critical illness insurance system for urban and rural residents plays an important role in alleviating the burden of medical treatment for urban and rural residents, and the problems existing in the operation of the serious illness insurance system for urban and rural residents need to be solved urgently.
Based on the theoretical perspective of Mezmani and Sabatier integrated model, this paper selects the factors that may affect the implementation of the critical illness insurance policy for urban and rural residents from the aspects of the policy itself and variables outside the policy, and puts forward targeted suggestions on this basis.
Secondly, on the basis of the relevant data of the serious illness insurance for urban and rural residents in Fangshan District and the one-on-one interviews and case analysis of 12 managers and 28 urban and rural residents of the serious illness insurance for urban and rural residents in Fangshan District, it is concluded that the following problems exist in the operation of the serious illness insurance for urban and rural residents in Fangshan District: the reimbursement cycle is too long due to insufficient multi-department linkage, the pressure on fund expenditure, the controversy over the setting of compensation schemes, and the lack of supervision and management. The awareness of the policy is not high. Based on the results of the interviews, combined with the integrated model of Mezmani and Sabatier, the influencing factors and reasons for the implementation of the policy were analyzed. The factors of the policy itself include the insufficient financing mechanism, the compensation system needs to be improved, and the reimbursement process mechanism is unreasonable; Factors other than the policy itself include the low efficiency of policy implementers, the lack of strict and effective regulatory mechanisms, the lack of policy publicity, and the need to improve the technical environment. On this basis, combined with the actual situation of Fangshan District and drawing on the experience of other districts and counties in Beijing, this paper puts forward targeted countermeasures to optimize the serious illness insurance of urban and rural residents in Fangshan District: improve the financing mechanism and reimbursement process mechanism, establish a scientific serious illness compensation mechanism, improve the work efficiency of handling personnel, strengthen policy publicity, improve the technical environment, and improve the supervision mechanism.