本文選題：新型農(nóng)村合作醫(yī)療　切入點(diǎn)：單病種　出處：《湖北中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：目的 (1)了解調(diào)查地區(qū)新農(nóng)合運(yùn)行情況,以及單病種付費(fèi)在病種選擇、費(fèi)用標(biāo)準(zhǔn)制定、補(bǔ)償機(jī)制方面的實(shí)施情況。 (2)調(diào)查單病種付費(fèi)的實(shí)施對醫(yī)務(wù)人員及患者的影響及其評價(jià)。 (3)探究調(diào)查地區(qū)單病種付費(fèi)運(yùn)行中存在的問題及相關(guān)配套制度。 (4)提出完善單病種付費(fèi)的建議。 方法 (1)文獻(xiàn)研究 利用中國知網(wǎng)、萬方數(shù)據(jù)庫、重慶維普、pubMed等數(shù)據(jù)庫,政府及醫(yī)療機(jī)構(gòu)官方網(wǎng)站和相關(guān)統(tǒng)計(jì)年鑒,以及百度百科、百度文庫、維基百科等網(wǎng)絡(luò)資源,總結(jié)國內(nèi)外關(guān)于支付方式效果研究,尤其是我國新農(nóng)合單病種付費(fèi)的研究文獻(xiàn)。 (2)現(xiàn)場調(diào)查研究 為了更加全面、深入地分析湖北省新農(nóng)合單病種付費(fèi)的實(shí)施效果,本研究根據(jù)典型抽樣的方法,在湖北省選擇武漢江夏區(qū)、當(dāng)陽市、宣恩縣作為調(diào)查地點(diǎn)。對當(dāng)?shù)匦罗r(nóng)合經(jīng)辦機(jī)構(gòu)、定點(diǎn)醫(yī)療機(jī)構(gòu)、患者進(jìn)行現(xiàn)場訪談和調(diào)查問卷,了解新農(nóng)合按病種付費(fèi)在當(dāng)?shù)氐拈_展及運(yùn)行情況。 (3)重要知情人訪談 訪談對象：調(diào)查地區(qū)新農(nóng)合經(jīng)辦機(jī)構(gòu)相關(guān)負(fù)責(zé)人、醫(yī)療機(jī)構(gòu)管理者、臨床醫(yī)護(hù)人員代表。 訪談內(nèi)容：’新農(nóng)合單病種病種選擇的依據(jù)、單病種付費(fèi)標(biāo)準(zhǔn),政策是如何宣傳和開展的,在實(shí)施中遇到哪些問題和困難,探討相關(guān)解決途徑與方案。 (4)對比分析法 對上述3個(gè)地區(qū)新農(nóng)合按病種付費(fèi)在病種選擇、單病種費(fèi)用標(biāo)準(zhǔn)的制定、實(shí)施效果等方面進(jìn)行比較分析,總結(jié)各自的實(shí)施情況、遇到的困難、擬采取的措施。 結(jié)果 (1)調(diào)查地區(qū)新農(nóng)合發(fā)展較好,近年來參合人數(shù)、參合率、籌資水平逐年提高。 (2)單病種付費(fèi)項(xiàng)目確實(shí)對控制醫(yī)療費(fèi)用的不合理增長起到了一定作用,對醫(yī)療質(zhì)量的影響有待研究,新農(nóng)合經(jīng)辦機(jī)構(gòu)也采取了系列措施監(jiān)督醫(yī)療機(jī)構(gòu)。 (3)醫(yī)務(wù)人員對單病種付費(fèi)項(xiàng)目的知曉度和接受程度較高,同時(shí)也認(rèn)為單病種付費(fèi)存在減低醫(yī)療服務(wù)質(zhì)量風(fēng)險(xiǎn)。 (4)患者主要從經(jīng)辦機(jī)構(gòu)駐村宣傳以及醫(yī)院宣傳等途徑知曉單病種付費(fèi),對整個(gè)單病種付費(fèi)項(xiàng)目比較滿意,認(rèn)為減輕了家庭就醫(yī)經(jīng)濟(jì)負(fù)擔(dān),同時(shí)希望有關(guān)部門對定點(diǎn)醫(yī)院加強(qiáng)管理和監(jiān)督。 結(jié)論 (1)完善定額支付標(biāo)準(zhǔn),修正標(biāo)準(zhǔn)臨床路徑 (2)完善我國單病種付費(fèi)醫(yī)療質(zhì)量評價(jià)體系 (3)提高需方的知曉率和醫(yī)務(wù)人員的積極性 (4)加強(qiáng)對醫(yī)院的監(jiān)督與信息公開 (5)新農(nóng)合支付方式改革時(shí)應(yīng)積極探索混合支付方式
[Abstract]:Purpose(1) to understand the operation of NCMS in the investigation area, and the implementation of single-disease payment in the aspects of disease selection, cost standard formulation and compensation mechanism.(2) to investigate the effect and evaluation of single-disease payment on medical staff and patients.3) to explore the problems existing in the operation of single-disease payment in the investigation area and related supporting systems.4) put forward the suggestion of perfecting the payment of single disease.Method1) Literature studyUsing such databases as China.com. com, Wanfang Database, Chongqing Weipu pubMed, the official websites of government and medical institutions and related statistical yearbooks, as well as online resources such as Baidu Encyclopedia, Baidu Library, Wikipedia, etc.This paper summarizes the domestic and international research on the effect of payment methods, especially the research literature on the payment of single disease of new agricultural cooperation in China.Field investigation and studyIn order to analyze the effect of payment for single disease in Hubei province, this study selected Jiangxia District, Dangyang City and Xuanen County in Hubei Province as the investigation sites according to the typical sampling method.The local NCMS agencies, designated medical institutions and patients were interviewed and investigated in order to understand the development and operation of NCMS by disease type.3) interviews with important insidersInterview subjects: the responsible persons of the new rural cooperative agencies, the managers of the medical institutions, and the representatives of the clinical medical staff.The contents of the interview were as follows: 1. The basis of selection of single disease species in New Rural Cooperation, the standard of single disease payment, how to propagate and carry out the policy, the problems and difficulties encountered in the implementation, and the relevant solutions and solutions.Comparative analysisThis paper makes a comparative analysis on the selection of disease species, the establishment of cost standard for single disease species and the effect of implementation in the three areas mentioned above, and summarizes the implementation situation, difficulties encountered and measures to be taken.ResultIn recent years, the number of participants, the rate of participation and the level of financing have increased year by year.(2) the single disease payment project does play a certain role in controlling the unreasonable increase of medical expenses, and the influence on medical quality needs to be studied. The new rural cooperative agency has also taken a series of measures to supervise medical institutions.3) the medical staff have a higher degree of knowledge and acceptance of the single disease payment item, and it is also considered that the single disease payment has the risk of reducing the quality of medical service.(4) patients are aware of the payment of single disease mainly from the channels of village propaganda and hospital publicity, and are satisfied with the payment project of the whole single-disease category, and think that the financial burden of family medical treatment has been alleviated.At the same time, I hope the relevant departments to strengthen the management and supervision of designated hospitals.Conclusion1) improve the standard of quota payment and revise the standard clinical pathway2) perfecting the quality evaluation system of paid medical treatment for single disease in China3) improve the awareness of the demand side and the enthusiasm of the medical staff(4) strengthening the supervision and information disclosure of hospitals5) when the new rural cooperative payment mode is being reformed, the mixed payment method should be actively explored.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R197.1;F842.684;F323.89

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