本文選題：杭州市　切入點：基本醫(yī)療保險　出處：《浙江財經(jīng)大學(xué)》2014年碩士論文

【摘要】：自從城鎮(zhèn)基本醫(yī)療保險制度建立以來，各地都在積極探索行之有效的醫(yī)保付費方式。2009年新舊醫(yī)改轉(zhuǎn)折之年后，醫(yī)療保險支付方式改革更是成為了深化我國醫(yī)藥體制一個熱門的話題。城鎮(zhèn)基本醫(yī)療保險支付方式在保障參保人的權(quán)益、規(guī)范醫(yī)療服務(wù)行為、控制醫(yī)療費用增長和促進(jìn)醫(yī)療機(jī)構(gòu)發(fā)展等方面都發(fā)揮了中流砥柱的作用。而在醫(yī)療衛(wèi)生體制深化的過程當(dāng)中，城鎮(zhèn)基本醫(yī)保支付方式改革注定被賦予了更多的責(zé)任和期望。 開展基本醫(yī)保支付方式改革的目的有三方面：一、重新構(gòu)建醫(yī)療服務(wù)機(jī)構(gòu)收費和補償機(jī)制；二、促進(jìn)衛(wèi)生資源的合理配置，減少不合理的醫(yī)療資源浪費行為；三、控制醫(yī)療費用的過快增長。 本文分為五個部分，文章第一部分以我國“看病難，看病貴”的現(xiàn)狀為切入口，提出了衛(wèi)生總費用過高和個人醫(yī)療負(fù)擔(dān)過重的大背景，醫(yī)療支付方式改革作為深化醫(yī)藥體制改革的任務(wù)之一，對于降低衛(wèi)生費用和減輕個人醫(yī)療負(fù)擔(dān)起到至關(guān)重要的作用。研究用了文獻(xiàn)法律法規(guī)分析法、個案分析法和統(tǒng)計分析法。文獻(xiàn)法律法規(guī)分析法的運用主要在對相關(guān)法律法規(guī)的歸納基礎(chǔ)上，，對杭州市醫(yī)保支付方式改革作脈絡(luò)整理。個案分析法是將杭州市城鎮(zhèn)基本醫(yī)保支付方式改革作為案例，加以統(tǒng)計分析法對杭州市醫(yī)保支付方式改革進(jìn)行量化評估。第二部分從醫(yī)保支付方式理論支撐著手，通過對不同支付方式的利弊進(jìn)行簡要分析，用選擇支付方式和醫(yī)保費用支付之間的相關(guān)關(guān)系圖來對比不同醫(yī)保支付方式的控費效果、服務(wù)質(zhì)量效果和管理效果。第三部分以浙江省杭州市城鎮(zhèn)基本醫(yī)療保險支付方式改革作為案例。回顧了杭州市醫(yī)保支付方式以新醫(yī)改為時間拐點下的兩個階段的大致情況：杭州市新醫(yī)改前主要是以單一的按項目付費為主的醫(yī)保支付方式，新醫(yī)改后主要是以總額預(yù)算為基礎(chǔ)，按項目付費、按單病種付費、按人頭付費這四種支付方式混合作為最主要的支付方式。在對杭州市醫(yī)保支付方法改革有了定性的概述后，對杭州市歷年醫(yī)保基金的收支結(jié)余、人均醫(yī)保支出、人均醫(yī)保報銷率、個人負(fù)擔(dān)、對醫(yī)院的收支效果評估以及單病種付費效果等方面對杭州市醫(yī)保支付方式進(jìn)行綜合效果評估。結(jié)合相對全面的醫(yī)保支付方式定性描述和定量分析，對評估結(jié)果進(jìn)行評價，肯定了杭州市新醫(yī)改下醫(yī)保支付方式取得的積極成效，也提出了新醫(yī)改下的城鎮(zhèn)醫(yī)保支付方式仍然存在著不足需要改進(jìn)之處。第四部分在借鑒國外德國、英國、美國和國內(nèi)城市上海、北京、東莞支付方式較為多元化的支付方式，并結(jié)合當(dāng)前杭州市醫(yī)保效果評估，提出針對杭州市醫(yī)保支付方式不足之處具有借鑒意義的經(jīng)驗。最后筆者綜合上述四大部分對杭州市城鎮(zhèn)基本醫(yī)療保險改進(jìn)提出了頗具意義的建議。主要針對性建議包括五大方面：繼續(xù)推進(jìn)總額預(yù)算為核心的混合支付方式道路上，需要加強(qiáng)醫(yī)�；痤A(yù)算管理與監(jiān)管，完善基本藥物零差率銷售制度、不但要建立科學(xué)合理的混合支付方式，更要積極發(fā)揮外圍配套措施的作用。在本文最后，筆者對文章進(jìn)行了結(jié)論，并在展望中暢想了杭州市理想的醫(yī)保支付方式改革路線圖。 杭州市醫(yī)保支付改革在2010年伊始，如今進(jìn)入第四個年頭，以“總額預(yù)付”為主的混合支付方式初具雛形。但在關(guān)于杭州市醫(yī)保支付改革的文獻(xiàn)中，尚未有相關(guān)學(xué)者對其進(jìn)行過研究，筆者在探究杭州市醫(yī)保支付問題上屬于少數(shù)，盡管由于關(guān)于財務(wù)信息的保密性，數(shù)據(jù)的采集阻力重重，但仍然通過不懈的努力查閱到了相關(guān)資料并得以分析研究的繼續(xù)工作，希望對推動杭州市城鎮(zhèn)基本醫(yī)療保險改革起到一些建設(shè)性意見的作用。
[Abstract]:Since the basic medical insurance system since the establishment of the country are actively exploring the effective way of Medicare payment.2009 years old and the new health care reform turning point of the year after the reform of the medical insurance payment is to become the deepening of China's medical system is a hot topic. The rights and interests of the urban basic medical insurance payment in the insured persons, standardize the medical service behavior, control medical expenses of medical institutions to promote growth and development plays a mainstay role. In the process of deepening medical and health system, urban basic medical insurance payment reform to be given more responsibility and expectations.
There are three ways to carry out the reform of basic medical insurance payment system: first, rebuild the medical service institutions' charging and compensation mechanism; two, promote the rational allocation of health resources, reduce irrational medical resources waste; three, control the excessive growth of medical expenses.
This paper is divided into five parts, the first part of this article to our country "difficult and expensive situation" as the entrance, the total health costs are too high and the burden of the personal medical background, medical payment reform as one of the deepening medical reform tasks, to reduce health costs and reduce the burden of personal health to study the important role of laws and regulations. The literature analysis, case analysis and statistical analysis. The analysis of the laws and regulations mainly used in induction on the basis of the relevant laws and regulations, in Hangzhou, the reform of the medical insurance payment sequence finishing. Case analysis is the Hangzhou urban basic medical insurance payment reform as an example, analyzed the method of payment reform in Hangzhou city health assessment. The second part from the theoretical support to the medical insurance payment, according to A brief analysis of the advantages and disadvantages of the same payment, choose to pay by way of payment and insurance between the diagram to compare different medical insurance payment cost control effect, the effect of service quality and management effect. In the third part, taking Hangzhou city of Zhejiang Province, the urban basic medical insurance payment reform. As a case review of Hangzhou City medical insurance payment in the new medical reform of the two stages of time under the inflection point of Hangzhou city before reform is mainly based on single fee based medical insurance payment, the new medical reform is mainly based on the total budget as basis, paid by the project, according to the single DRGs, capitation payment as the four mixed the main payment way. In the city of Hangzhou with the reform of Medicare payment method qualitative overview, in past years in Hangzhou city health insurance fund balance, per capita health expenditure, The per capita Medicare reimbursement rate, individual burden of Hangzhou Medicare payment balance and effect evaluation of hospital DRGs and other aspects of the effect of comprehensive evaluation. Combined with the relatively comprehensive medical insurance payment analysis of qualitative description and quantitative assessment of the results of the evaluation, positive results have been achieved in Hangzhou City, the new medical insurance payment next, put forward under the new medical reform of urban medical insurance payment still exist deficiencies need to be improved. The fourth part from abroad in Germany, Britain, the United States and the city of Shanghai, Beijing, Dongguan payment payment is more diversified, and combined with the assessment of the current health care effect of Hangzhou City, put forward Hangzhou City medical insurance payment deficiency of meaningful experience. Finally the author integrated the above four most of Hangzhou city basic medical insurance is proposed Meaningful proposals. The main suggestions include five aspects: Road mixed payment continue to promote the total budget as the core, the need to strengthen the medical insurance fund budget management and supervision, improve the basic drug zero sales slip system, not only to establish a scientific and reasonable mixed payment, but also to actively play the role of peripheral supporting measures. At the end of this paper, the author has carried on the conclusion of the article, and in the future the imagination of a Hangzhou City ideal Medicare payment reform roadmap.
Hangzhou City medical insurance payment reform at the beginning of 2010, is now in the fourth year, in the "total amount of prepaid based mixed payment to take shape. But in the city of Hangzhou Medicare payment reform in the literature, there is no relevant scholars have done research on it, the author paid on the research of Hangzhou health care problem belongs to the minority, although the about the confidentiality of financial information, collect data but still heavy resistance, through the unremitting efforts of access to relevant information and analysis of the research work, we hope to promote the Hangzhou city basic medical insurance reform to some constructive comments.

【學(xué)位授予單位】：浙江財經(jīng)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：F842.684;R197.1

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