發(fā)布時(shí)間：2018-05-30 20:39

  本文選題：公立醫(yī)院 + 軍隊(duì)醫(yī)院��； 參考：《第二軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：研究目的公立醫(yī)院補(bǔ)償機(jī)制是我國深化醫(yī)藥衛(wèi)生體制改革的核心和關(guān)鍵,軍隊(duì)醫(yī)院作為特殊的公立醫(yī)院,要順應(yīng)醫(yī)療改革的政策,但卻沒有針對(duì)軍隊(duì)醫(yī)院補(bǔ)償機(jī)制的政策,迫使軍隊(duì)醫(yī)院必須尋求自己的出路。本研究在公立醫(yī)院改革補(bǔ)償機(jī)制的背景下,采用對(duì)兩所軍隊(duì)醫(yī)院醫(yī)務(wù)人員面對(duì)面訪談、四所軍隊(duì)醫(yī)院患者問卷調(diào)查和其中一所訪談軍隊(duì)醫(yī)院醫(yī)療服務(wù)信息三個(gè)途徑獲取數(shù)據(jù),對(duì)其進(jìn)行整理和分析,提出軍隊(duì)醫(yī)院的費(fèi)用補(bǔ)償機(jī)制及執(zhí)行措施,為新醫(yī)改下軍隊(duì)醫(yī)院的正常運(yùn)轉(zhuǎn)、持續(xù)發(fā)展和改革設(shè)計(jì)提供理論依據(jù)和數(shù)據(jù)支撐。將本研究結(jié)果和主課題相結(jié)合,探索有效的補(bǔ)償途徑,降低試錯(cuò)成本,更合理和高效地完善補(bǔ)償機(jī)制。資料與方法1、資料來源:政策文件和研究文獻(xiàn)分別來源于網(wǎng)站檢索和電子期刊數(shù)據(jù)庫,訪談資料來源于對(duì)兩所軍隊(duì)醫(yī)院20名醫(yī)務(wù)人員的訪談,問卷調(diào)查資料來源于四所軍隊(duì)醫(yī)院283名就診患者的現(xiàn)場作答,2010年07月01日-2013年06月30日X軍隊(duì)醫(yī)院醫(yī)療服務(wù)信息,提取于其中一所訪談軍隊(duì)醫(yī)院軍衛(wèi)1號(hào)系統(tǒng)。2、研究方法:首先,通過文獻(xiàn)檢索進(jìn)行理論分析和綜合述評(píng),撰寫訪談提綱和設(shè)計(jì)調(diào)查問卷;其次,開展面對(duì)面的訪談和現(xiàn)場實(shí)地調(diào)查,搜集相關(guān)信息和數(shù)據(jù),并利用Epidata3.1、spss18.0進(jìn)行整理、錄入和分析;第三,利用Excel2007、SAS9.2統(tǒng)計(jì)軟件,對(duì)收集到的軍隊(duì)醫(yī)院軍地患者的醫(yī)療服務(wù)信息進(jìn)行整體數(shù)據(jù)和各項(xiàng)醫(yī)療服務(wù)參數(shù)分布的分析;最后,采用比較分析法探討與軍隊(duì)醫(yī)院相匹配的費(fèi)用補(bǔ)償機(jī)制。研究結(jié)果1、通過訪談發(fā)現(xiàn),軍隊(duì)醫(yī)院的醫(yī)務(wù)工作者一致贊成“取消藥品加成”政策,但認(rèn)為取消藥品加成將降低軍隊(duì)醫(yī)院的收入和為軍隊(duì)官兵服務(wù)的水平,造成軍隊(duì)和地方的人才進(jìn)一步流失,影響軍隊(duì)醫(yī)院的整體發(fā)展。2、問卷調(diào)查表明,藥品費(fèi)用占門診費(fèi)用70%以上,患者擔(dān)心取消藥品加成后其它費(fèi)用會(huì)增加。七成以上的被調(diào)查者接受新門診收費(fèi)標(biāo)準(zhǔn),新門診收費(fèi)標(biāo)準(zhǔn)將增加主任醫(yī)師和知名專家的門診量,近四成的被調(diào)查者依然認(rèn)為藥品價(jià)格較高且因藥品價(jià)格過高而感到不理解和無奈。3、醫(yī)療數(shù)據(jù)揭示,某軍隊(duì)醫(yī)院的門診占總診療人次的91.7%(2105182人次),住院占總診療人次的8.3%(189848人次),84.3%診療人次為地方人員。對(duì)外醫(yī)療收入中,藥品收入占39.3%,醫(yī)療服務(wù)收入占60.7%,藥品占比逐年下降,藥品降幅大于醫(yī)療服務(wù)收入;醫(yī)療服務(wù)收入中,檢查檢驗(yàn)、治療和材料收入占比較高。門診對(duì)外醫(yī)療中,自費(fèi)人員診療人次(60.8%)和費(fèi)用(57.9%)占比最高;病人次均醫(yī)藥費(fèi)低于問卷調(diào)查醫(yī)院;收入逐年上升,藥品收入占48.6%,醫(yī)療服務(wù)收入占51.4%。住院對(duì)外醫(yī)療中,三年間總住院人次先增后減,地方住院患者占89.3%,自費(fèi)人次占50.5%,地方醫(yī)保病人占比上升到38.8%;住院收入先漲后降,平均住院天數(shù)和次均住院費(fèi)逐年下降,每床日均住院費(fèi)用逐年上升;藥品收入占37.5%,醫(yī)療服務(wù)收入占62.5%;醫(yī)療服務(wù)收入中,材料費(fèi)占比最高,其次是檢驗(yàn)檢查和治療收入。藥品支出占全院支出最高(49.7%),其次是材料支出(28.7%);人力成本支出中,績效補(bǔ)貼占62.4%,工資占17.9%。結(jié)論和建議目前軍隊(duì)醫(yī)院的補(bǔ)償主要存在缺乏地方政府補(bǔ)償、醫(yī)療服務(wù)價(jià)格體系不合理、醫(yī)保補(bǔ)償機(jī)制不完善、軍隊(duì)醫(yī)院人才流失、患者對(duì)改革可能帶來的不良后果心存疑慮等問題。為推動(dòng)我國軍隊(duì)醫(yī)院補(bǔ)償機(jī)制的完善,應(yīng)當(dāng)因地制宜的建立按量補(bǔ)償機(jī)制,按照醫(yī)院的級(jí)別和規(guī)模來進(jìn)行補(bǔ)償;通過增設(shè)醫(yī)事服務(wù)費(fèi),調(diào)整醫(yī)療服務(wù)收費(fèi),建立合理的價(jià)格體系;改進(jìn)目前醫(yī)療保險(xiǎn)的支付體系,完善醫(yī)保制度,減輕患者負(fù)擔(dān);及時(shí)制定給予聘用制工作人員的補(bǔ)償措施,加大補(bǔ)償力度;加強(qiáng)相關(guān)政策的宣傳和強(qiáng)力監(jiān)督。
[Abstract]:The compensation mechanism of public hospitals is the core and key of deepening the reform of the medical and health system in our country. As a special public hospital, military hospitals should comply with the policy of medical reform, but there is no policy against the compensation mechanism of military hospitals, which compels military hospitals to seek their own way out. This research is made in public hospital reform and compensation. Under the background of the mechanism, two medical personnel in military hospitals were interviewed face-to-face, four military hospital patients questionnaire survey and one interview with military hospital medical service information were used to obtain data. The data were collected and analyzed, and the compensation mechanism and implementation measures of military hospitals were put forward, for the military hospitals under the new medical reform. The theoretical basis and data support are provided for normal operation, continuous development and reform design. The results of this study are combined with main subjects to explore effective compensation ways, reduce the cost of trial and error, and improve the compensation mechanism more reasonably and efficiently. Data and methods 1, source of information and research documents are derived from web search and electronic period, respectively. The interview data came from interviews with 20 medical personnel in two military hospitals. The questionnaire survey data came from 283 medical patients in four military hospitals, and the medical service information of X military hospital on 06 month 30 of 2010 -2013 was extracted from one of the military hospital military and Wei No. 1 system.2, which was interviewed. First, through the literature search for theoretical analysis and comprehensive review, write interview outline and design questionnaire; secondly, carry out face-to-face interviews and field investigation, collect relevant information and data, and use Epidata3.1, SPSS18.0 to organize, input and analysis; third, the use of Excel2007, SAS9.2 statistical software, to collect the army Analysis of the overall data and the distribution of medical service parameters in the medical service information of the army and land patients in the hospital. Finally, the comparative analysis method was used to discuss the cost compensation mechanism matched with the military hospital. Results 1, through interviews, it was found that the medical workers in the military hospital agreed that the policy of "canceling the addition of drugs" was unanimous. The abolition of drug addition will reduce the income of military hospitals and the level of service for military officers and soldiers, resulting in the further loss of military and local personnel, affecting the overall development of military hospitals.2. The questionnaire survey shows that the cost of medicine accounts for more than 70% of the out-patient expenses, and the patients fear that the other costs will increase after the abolition of drugs. More than 70% are investigated. The new outpatient charge standard, the new outpatient charge standard will increase the outpatient quantity of the chief physician and the well-known expert, nearly 40% of the respondents still think that the price of the drug is high and the drug price is too high, it is not understood and helpless.3. Medical data reveal that the outpatient of a military hospital accounts for 91.7% (2105182 people) of the total number of patients. The hospital accounted for 8.3% (189848 person times) of total diagnosis and treatment. 84.3% of the medical treatment income, medical income accounted for 39.3%, medical service income accounted for 60.7%, drug proportion decreased year by year, drug decline was greater than medical service income; medical service income, inspection and inspection, treatment and material income accounted for more. Outpatient medical treatment, outpatient medical treatment, The person time (60.8%) and the cost (57.9%) accounted for the highest rate; the medical expenses of the patients were lower than the questionnaire survey Hospital; the income increased year by year, the drug income accounted for 48.6%, the medical service income accounted for the 51.4%. inpatient medical treatment, the total number of inpatients in the three years was first increased and then decreased, the local inpatients accounted for 89.3%, and the patient accounted for 50.5%, and the local medical insurance patients. The proportion of the occupation was up to 38.8%, the hospitalization days and the average hospitalization expenses decreased year by year, the average daily hospitalization expenses of each bed increased year by year, the medical income accounted for 37.5%, the medical service income accounted for 62.5%, the medical service income, the material cost was the highest, the second was the inspection and treatment income, and the drug expenditure accounted for the highest expenditure (49.7). The second is material expenditure (28.7%); in the human cost expenditure, the performance subsidies account for 62.4%, and the salary accounts for the 17.9%. conclusion and the suggestion that the compensation of the military hospital is mainly lack of local government compensation, the price system of medical service is not reasonable, the medical insurance compensation mechanism is not perfect, the brain drain of the military hospital and the adverse consequences that the patients may bring to the reform In order to improve the compensation mechanism of military hospitals in our country, we should build up the compensation mechanism according to the level and scale of the hospital according to the local conditions, adjust the medical service charge, adjust the medical service charge, establish a reasonable price system, improve the current medical insurance payment system, and improve the medical insurance system. In order to reduce the burden of patients, we should make timely compensation measures for the staff of the appointment system, increase the intensity of compensation, and strengthen publicity and strong supervision of relevant policies.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R82

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