本文選題：衛(wèi)生服務(wù)包 + 城鎮(zhèn)居民醫(yī)保　； 參考：《第四軍醫(yī)大學(xué)》2013年博士論文

【摘要】：黨中央將人人享有基本醫(yī)療衛(wèi)生服務(wù)確定為全面建成小康社會的重要目標之一，建設(shè)覆蓋城鄉(xiāng)居民的包括居民基本醫(yī)療保險制度的三大基本醫(yī)療衛(wèi)生制度。論文旨在通過探討建立適合城鎮(zhèn)居民需要的“基本衛(wèi)生服務(wù)包”理論方法，分析城鎮(zhèn)居民對醫(yī)療保險的認知、需求、支付意愿和支付能力，提出設(shè)計符合我國國情的城鎮(zhèn)居民醫(yī)保衛(wèi)生服務(wù)包的建議，為我國建立完善城鄉(xiāng)一體、預(yù)防、醫(yī)療、保健一體的基本醫(yī)療衛(wèi)生制度和醫(yī)療衛(wèi)生體系提供依據(jù)。 基本衛(wèi)生服務(wù)包設(shè)計的最主要問題是如何提高衛(wèi)生服務(wù)產(chǎn)品的效率，需要分析其成本和可利用的資源，然后調(diào)整包含的內(nèi)容，直到包含的項目內(nèi)容和可供利用的資源水平達到一個平衡。 成本效果分析是一種使有限的資源得到最有效利用的技術(shù)，分析評價健康項目利用的資源和獲得健康效益的方法，通過使用成本效果分析，決策者可以從這些項目中進行選擇。雖然成本效果分析不能告訴我們社會應(yīng)該從事哪種健康服務(wù)，但是提供了一個關(guān)于健康項目的效果和效率的信息的框架。有了這些結(jié)果之后，消費者和衛(wèi)生政策的制定者可以對采納何種項目作出明智、科學(xué)的決策。但是，在設(shè)計衛(wèi)生服務(wù)包時，也應(yīng)充分考慮社會體制、公眾偏好等社會因素。 實證研究主要采用入戶問卷調(diào)查方法。利用國家統(tǒng)計系統(tǒng)基點，由西安市、寶雞市、廣州市和珠海市城調(diào)隊入戶調(diào)查，樣本代表性和問卷可信度較高。其中西安市、寶雞市、廣州市和珠海市分別收回有效問卷350份、150份、447份和150份。 調(diào)查表明：四城市分別有25.21%、30.67%、45.94%和40%的家庭衛(wèi)生支出率超過其承受能力，顯示四城市現(xiàn)階段醫(yī)療支出能力較弱，衛(wèi)生支出負擔(dān)較重。西安有51.7%的居民能承受目前的繳費水平，有41.1%的居民能承受但對生活有一定影響。寶雞和廣州有超過60%的居民能承受但對生活有一定影響，大約20%的居民能夠承受目前的繳費水平。珠海有55.3%的居民能承受但對生活有一定影響，有32.7%的居民能承受目前的繳費水平。西安和寶雞有大約90%的調(diào)查家庭同時購買了職工保險，分別有30.9%和26.7%的家庭購買了商業(yè)保險；廣州和珠海的調(diào)查家庭同時購買職工保險的比例大大降低。 四城市大部分居民家庭因為報銷比例低而擔(dān)心看病費用問題，其次是因為報銷手續(xù)麻煩擔(dān)心。西安、寶雞和珠海大部分居民都認為醫(yī)療費用應(yīng)占家庭收入的合理比例為1%-10%，其次是10%-20%；廣州大部分居民認為醫(yī)療費用應(yīng)占家庭收入的合理比例為5%-10%，其次是20%-30%。四城市大部分居民認為醫(yī)保繳費應(yīng)占家庭收入的合理比例是1%-5%，其次，西安、寶雞和廣州認為醫(yī)保繳費占比應(yīng)為1%以下，珠海認為應(yīng)為5%-10%。仍有相當比例的居民認為應(yīng)為10%-20%或更高。四城市大部分居民認為個人交費占比應(yīng)為30%以下，有超過半數(shù)的居民認為個人交費占比應(yīng)為10%以下，西安和寶雞認為個人占比應(yīng)為10%以下的居民比例高于廣州和珠海，廣州和珠海認為個人占比應(yīng)為10%-30%的居民比例高于西安和寶雞。 寶雞、廣州和珠海最想增加的三項報銷項目分別是急診診療、藥店買藥和門診取藥，而西安最想增加的三項報銷項目分別是藥店買藥、急診診療和門診診療。四城市居民在居民醫(yī)保應(yīng)該針對的主要大項方面比較一致，主要集中在常見病、多發(fā)病和大病，預(yù)防、保健和急診方面反而比例較低。絕大部分居民認為應(yīng)該增加口腔門診治療，其次為口腔保健和口腔住院治療。其中，西安和寶雞居民認為居民醫(yī)保首先應(yīng)該增加的口腔門診項目是補牙和鑲牙，而廣州和珠海居民認為是定期口腔檢查。西安和寶雞居民家庭對居民醫(yī)保改革的主要關(guān)注點是簡化報銷手續(xù)，其次才是降低共付比例，而廣州和珠海更加關(guān)注降低共付比例，其次是降低起付線。 為使城鎮(zhèn)居民醫(yī)保更好地滿足群眾需要，必須采用成本效果分析方法，，更加合理地設(shè)計衛(wèi)生服務(wù)包，有效使用衛(wèi)生資源。同時應(yīng)：加大居民醫(yī)保宣傳力度，增強居民對醫(yī)保的認識和了解。簡化居民醫(yī)保使用與報銷手續(xù)，提高居民使用醫(yī)保便利程度。增加多元籌資水平，滿足不同人群需要，合理配置醫(yī)療資源，提升社區(qū)衛(wèi)生服務(wù)水平。從而使城鎮(zhèn)居民醫(yī)保更加完善，為全民覆蓋的醫(yī)療保障體制創(chuàng)造條件。
[Abstract]:The Central Committee of the party has identified the basic medical and health services for all as one of the important goals of building a well-off society in an all-round way, and building three basic medical and health systems covering urban and rural residents, including the basic medical insurance system for residents. The thesis aims to establish the theory and method of "basic health services package" for urban residents. This paper analyzes the cognition, demand, willingness to pay and payment ability of urban residents to medical insurance, and puts forward the suggestions for the design of medical insurance packages for urban residents in accordance with the national conditions of our country, and provides the basis for the establishment and improvement of the basic medical and health system and health system of the integrated urban and rural integration, prevention, medical treatment and health care in our country.
The main problem of the design of the basic health service package is how to improve the efficiency of the health service products, the need to analyze its cost and the available resources, and then adjust the contents of the included, until the content of the included projects and the level of available resources reach a balance.
Cost effectiveness analysis is a technology that makes the most effective use of limited resources. It analyzes and evaluate the resources used by health projects and the methods of obtaining health benefits. By using the cost effectiveness analysis, the decision-makers can choose from these projects. Although the cost effectiveness analysis does not tell us what kind of health clothing should be engaged in our society. But it provides a framework for information about the effectiveness and efficiency of health projects. After these results, consumers and health policy makers can make wise and scientific decisions on what kind of projects to adopt. However, social systems, public preferences, and other social factors should be taken into account in the design of health services.
The empirical study mainly adopts the household questionnaire survey method. Using the national statistical system base point, the survey of Xi'an, Baoji, Guangzhou and Zhuhai cities, the sample representation and the reliability of the questionnaire are high. Among them, Xi'an, Baoji, Guangzhou and Zhuhai have collected 350 valid questionnaires, 150, 447 and 150 respectively.
The survey showed that 25.21%, 30.67%, 45.94% and 40% of the four cities have more household health expenditure than their capacity, showing that four cities are weak in medical expenditure and the burden of health expenditure is heavy. 51.7% of the residents in Xi'an can bear the current level of payment, 41.1% of the residents can bear but have a certain impact on life. In the state, more than 60% of the residents can bear a certain impact on life, about 20% of the residents can bear the current level of payment. 55.3% of the residents in Zhuhai can bear but have a certain impact on their lives, and 32.7% of the residents can bear the current level of payment. In Xi'an and Baoji, about 90% of the survey families have also purchased employee insurance, respectively. 30.9% and 26.7% of households bought commercial insurance, while the proportion of employees surveyed in Guangzhou and Zhuhai greatly reduced their insurance coverage.
The majority of the residents in four cities are worried about the cost of seeing a doctor because of the low reimbursement rate. The second is because of the trouble of reimbursement. Most residents in Xi'an, Baoji and Zhuhai believe that the reasonable proportion of medical expenses should be 1%-10%, followed by 10%-20%; the majority of Guangzhou residents think that medical expenses should account for household income. The reasonable proportion is 5%-10%, followed by the majority of the residents in the 20%-30%. four city that the reasonable proportion of medical insurance contribution to the family income is 1%-5%. Secondly, Xi'an, Baoji and Guangzhou believe that the medical insurance contribution ratio should be less than 1%. Zhuhai believes that a considerable proportion of the residents of the 5%-10%. should be 10%-20% or higher. Four city residents recognize the majority of the residents. The proportion of individual payment should be less than 30%, and more than half of the residents think that the proportion of individual payment should be less than 10%. Xi'an and Baoji believe that the proportion of individuals who should be under 10% is higher than Guangzhou and Zhuhai, and Guangzhou and Zhuhai think that the proportion of individuals who should be 10%-30% is higher than that of Xi'an and Baoji.
Baoji, Guangzhou and Zhuhai are most likely to increase the three items of reimbursement, namely, emergency treatment, drugstore buying medicine and out-patient medicine, while Xi'an's most desirable three items of reimbursement are drugstores, emergency treatment and outpatient clinics. Four urban residents are more consistent in the major aspects of the residents' medical insurance, mainly in common diseases. The proportion of multiple diseases and major diseases, prevention, health care and emergency treatment is low. Most residents believe that oral outpatient treatment should be increased, followed by oral health care and oral inpatient treatment. Among them, residents in Xi'an and Baoji believe that the first oral outpatient items that residents should increase first are dental and dental inlay, while residents in Guangzhou and Zhuhai believe that The main concern for residents' health care reform in Xi'an and Baoji is to simplify reimbursement procedures, followed by reducing the proportion of CO payment, while Guangzhou and Zhuhai pay more attention to reducing the proportion of CO payment, followed by reducing the starting line.
In order to make the medical insurance of urban residents better to meet the needs of the masses, it is necessary to adopt the method of cost-effectiveness analysis, to design health-care packages more reasonably and to use health resources effectively. At the same time, we should increase the publicity of medical insurance, strengthen the residents' understanding and understanding of medical insurance, simplify the procedures for the use and reimbursement of residents' medical insurance, and improve the medical insurance for the residents. It is convenient to increase the level of multiple fund-raising, meet the needs of different populations, rationally deploy medical resources and improve the level of community health services, thus making the medical insurance of urban residents more perfect and creating conditions for the medical security system covered by the people.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：F842.684

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