本文關(guān)鍵詞： 醫(yī)療保險(xiǎn) 按病種支付 實(shí)行效果 費(fèi)用控制　出處：《南京醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目前,我國(guó)三大基本醫(yī)療保險(xiǎn)的參保率已經(jīng)提高到90%以上,基本實(shí)現(xiàn)了全民覆蓋。在當(dāng)前新醫(yī)改的大環(huán)境下,支付方式的選擇不僅關(guān)系到醫(yī)療費(fèi)用能否得到有效控制,而且關(guān)系到醫(yī)�；鸬氖罩胶夂歪t(yī)院的持續(xù)發(fā)展。按病種支付是醫(yī)保支付方式改革的成果之一。它通過(guò)制定預(yù)付標(biāo)準(zhǔn)來(lái)控制醫(yī)療服務(wù)提供者的總支出,使醫(yī)方承擔(dān)經(jīng)濟(jì)風(fēng)險(xiǎn),有效影響了醫(yī)療行為,并在一定程度上控制了不斷上漲的醫(yī)療費(fèi)用,使醫(yī)療服務(wù)公益性、公平性得到更好體現(xiàn)。如何更好地推行按病種支付、合理控制醫(yī)�；颊叩尼t(yī)療費(fèi)用,對(duì)維護(hù)患者利益、提高醫(yī)療保險(xiǎn)基金的運(yùn)行效率、提升患者的保障水平均具有重要的意義。目的:本文主要依據(jù)金壇市人民醫(yī)院按病種支付的實(shí)行效果進(jìn)行研究分析,研究按病種支付實(shí)行前后,醫(yī)院的經(jīng)濟(jì)運(yùn)行情況、住院醫(yī)保患者補(bǔ)償情況、特定病種醫(yī)療費(fèi)用補(bǔ)償和醫(yī)療負(fù)擔(dān)情況、特定病種的藥品使用行為的變化情況以及對(duì)醫(yī)療行為和醫(yī)療質(zhì)量的影響。了解該支付方式的實(shí)行效果及其存在問(wèn)題。方法:此次研究利用文獻(xiàn)研究法,搜集國(guó)內(nèi)外按病種支付有關(guān)方面的文獻(xiàn),為本課題的研究設(shè)計(jì)與調(diào)查實(shí)行提供理論指導(dǎo);運(yùn)用定量調(diào)查和定性訪談等方法,把金壇市人民醫(yī)院作為研究對(duì)象,通過(guò)研究該院的醫(yī)療行為主觀和客觀指標(biāo),比較該院自身實(shí)行病種支付方式改革前后醫(yī)療費(fèi)用及補(bǔ)償情況,深入研究特定病種的藥品使用行為變化情況,分析按病種支付的實(shí)行效果及存在問(wèn)題。研究結(jié)果:(1)醫(yī)�；颊叩馁M(fèi)用負(fù)擔(dān)得到顯著降低;(2)一定程度上規(guī)范了醫(yī)療行為,醫(yī)療質(zhì)量總體較好;(3)醫(yī)院效率有所提高;(4)有效降低了患者轉(zhuǎn)外的就診率。研究結(jié)論:本論文通過(guò)對(duì)金壇市人民醫(yī)院按病種支付的執(zhí)行效果以及對(duì)醫(yī)療行為的影響研究顯示:(1)按病種支付制度的執(zhí)行效果總體較好;(2)患者的醫(yī)療負(fù)擔(dān)得到了顯著的降低;(3)藥品費(fèi)用的控制仍是按病種支付執(zhí)行的重點(diǎn);(4)按病種支付執(zhí)行中存在一些問(wèn)題,有待改進(jìn)。建議:(1)科學(xué)制定按病種支付標(biāo)準(zhǔn);(2)調(diào)整支付標(biāo)準(zhǔn),實(shí)行彈性管理;(3)健全臨床路徑制度,科學(xué)管理臨床路徑的進(jìn)入和退出機(jī)制;(4)加大對(duì)醫(yī)療機(jī)構(gòu)的監(jiān)管力度;(5)完善信息支撐政策;(6)完善醫(yī)療保障制度;(7)提高中成藥的臨床使用率。
[Abstract]:At present, the participation rate of the three major basic medical insurance in our country has been raised to more than 90%, which has basically achieved universal coverage. Under the general environment of the current new health care reform, the choice of payment methods is not only related to whether the medical expenses can be effectively controlled, It is also related to the balance of income and expenditure of the medical insurance fund and the sustained development of the hospital. Paying according to disease is one of the achievements of the reform of the medical insurance payment mode. It controls the total expenditure of the medical service provider by establishing the standard of prepayment to make the medical party bear the economic risk. It effectively affects the medical behavior, and to some extent controls the rising medical expenses, so that the commonweal and fairness of the medical service can be better reflected. How to better implement the payment according to the kind of disease, and how to control the medical expenses of the medical insurance patients reasonably, It is of great significance to maintain the interests of patients, improve the operating efficiency of medical insurance fund and improve the level of patient protection. To study the economic operation of hospitals, the compensation of inpatient medical insurance patients, the compensation of medical expenses and the medical burden of specific types of diseases before and after the implementation of payment according to disease. The change of drug use behavior and its influence on medical behavior and quality of medical treatment. Understand the effect of the payment method and its existing problems. Methods: this study used the literature research method, Collect the literature about paying for the disease by disease at home and abroad, provide theoretical guidance for the research design and practice of this subject, use the methods of quantitative investigation and qualitative interview, take the people's Hospital of Jintan City as the research object. By studying the subjective and objective indexes of the hospital's medical behavior, comparing the medical expenses and compensation before and after the reform of the way of paying for the disease, and deeply studying the change of the drug use behavior of the specific disease, The research results show that the cost burden of medical insurance patients has been significantly reduced and the medical behavior has been regulated to a certain extent. The overall quality of medical treatment is better than 3) the efficiency of the hospital has been improved. 4) the rate of patients being transferred to hospital has been reduced effectively. Conclusion: this paper analyzes the effect of the people's hospital in Jintan on the effect of paying according to the disease type and the influence on the medical behavior. The study shows that the implementation of the pay system by disease is generally better. (2) the medical burden of patients has been significantly reduced. (3) the control of drug costs is still the key point in the implementation of payment by disease. 4) there are some problems in the implementation of payment by disease. It is suggested that: 1) establish scientifically the standard of payment according to the disease type and adjust the standard of payment, and implement elastic management to improve the system of clinical pathway. Scientific management of clinical pathway entry and exit mechanism (4) strengthen the supervision of medical institutions (5) improve the information support policy / 6) improve the medical security system / 7) improve the clinical use rate of Chinese patent medicine.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R197.1;F842.684

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 周鑫;吳正虎;;關(guān)于醫(yī)療費(fèi)用支付方式的探討[J];健康研究;2010年01期

2 李婷婷;顧雪非;馮奧;張振忠;;常熟市新農(nóng)合按病種付費(fèi)實(shí)施效果分析[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2010年05期

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本文編號(hào)：1529485