【摘要】：醫(yī)療保險是為人民群眾補償醫(yī)療費用的一種保險。由于醫(yī)療衛(wèi)生服務的高度專業(yè)性,導致保險者和被保險者之間的信息不對稱,加上醫(yī)生與患者的利益不完全一致,誘發(fā)了道德風險問題的產(chǎn)生。道德風險嚴重擾亂了保險功能的正常發(fā)揮,妨礙了醫(yī)療衛(wèi)生資源的有效配置。在醫(yī)療保險中存在事前道德風險和事后道德風險兩大類,其中事后道德風險對醫(yī)療保險基金的沖擊最大。 醫(yī)療保險涉及到政府、醫(yī)療保險機構(gòu)、醫(yī)療服務機構(gòu)和被保險者四個方面,但是政府作為管理部門不直接參與醫(yī)療保險的具體運作,只是起監(jiān)督和政策扶持作用。因此,醫(yī)療保險中的道德風險主要來源于醫(yī)保機構(gòu)、醫(yī)療服務機構(gòu)和被保險者三方。在解決醫(yī)療保險道德風險的過程中,醫(yī)療服務機構(gòu)是解決醫(yī)療保險道德風險的關(guān)鍵,也是影響被保險者道德風險的重要因素之一。 本文通過個案研究,以天津市某三甲醫(yī)院產(chǎn)科支付方式改革前后醫(yī)療費用變化為切入點,研究支付方式對醫(yī)患雙方道德風險的影響。一方面從理論上闡述了醫(yī)療保險道德風險的來源及影響因素,另一方面,結(jié)合天津市某三甲醫(yī)院醫(yī)療支付方式改革的實踐經(jīng)驗,進一步思考如何推進醫(yī)療保險支付方式向科學、合理的方向發(fā)展。研究醫(yī)療服務機構(gòu)的道德風險及其預防措施,對于保障醫(yī)療保險基金的穩(wěn)定性,醫(yī)療衛(wèi)生服務的公平性和可及性具有十分重要的意義。
[Abstract]:Medical insurance is a kind of insurance which compensates for the people's medical expenses. Due to the highly professional nature of the medical and health services, the information asymmetry between the insured and the insured, coupled with the incongruity of the interests of doctors and patients, leads to the emergence of moral hazard. Moral hazard seriously disturbs the normal function of insurance and hinders the effective allocation of medical and health resources. There are two types of moral hazard in medical insurance: moral hazard in advance and moral hazard after the event, in which moral hazard after the event has the greatest impact on the medical insurance fund. Medical insurance involves four aspects: government, medical insurance organization, medical service organization and insured person, but the government, as the management department, does not participate in the concrete operation of medical insurance directly, but only plays the role of supervision and policy support. Therefore, the moral hazard in medical insurance mainly comes from health care institutions, medical service organizations and insured persons. In the process of solving the moral hazard of medical insurance, medical service organization is the key to solve the moral hazard of medical insurance, and it is also one of the important factors that affect the moral hazard of insured person. Based on the case study, this paper studies the effect of payment mode on the moral hazard of doctors and patients by taking the change of medical expenses before and after the reform of obstetrical payment mode in a third Class A Hospital in Tianjin. On the one hand, the origin and influencing factors of medical insurance moral hazard are expounded theoretically. On the other hand, combining with the practical experience of medical payment mode reform in a third class hospital in Tianjin, the author further thinks about how to promote medical insurance payment mode to science. A reasonable direction of development. It is of great significance to study the moral hazard of medical service institutions and its preventive measures to ensure the stability of medical insurance fund and the fairness and accessibility of medical and health services.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：F842.684

【參考文獻】

相關(guān)期刊論文 前2條

1 劉婷;;社會醫(yī)療保險中道德風險防范與控制[J];改革與開放;2009年10期

2 程兆輝;陶紅兵;周俊;張汝檸;舒琴;;不同級別醫(yī)療機構(gòu)分娩方式的構(gòu)成及其成本分析[J];中國衛(wèi)生經(jīng)濟;2013年03期

相關(guān)碩士學位論文 前1條

1 王奉香;濟南市三縣新農(nóng)合居民住院費用影響因素研究[D];山東大學;2010年

，

本文編號：2133949