奉化市醫(yī)保付費(fèi)方式存在的問題與對策研究
發(fā)布時間：2018-07-28 06:35
【摘要】：醫(yī)保主要用于抵御因患病或傷害帶來的醫(yī)療風(fēng)險,減少因病至貧或因病返貧現(xiàn)象,而醫(yī)保付費(fèi)方式不僅保障醫(yī)療費(fèi)用支出恰當(dāng)合理,還可以控制醫(yī)療服務(wù)質(zhì)量。隨著社會發(fā)展,人們對健康需求的不斷提升,過度性的醫(yī)療消費(fèi)屢見不鮮,同時看病難、看病貴的情況充斥著社會,成為制約經(jīng)濟(jì)發(fā)展的難題。醫(yī)保付費(fèi)方式改革已經(jīng)成為社會關(guān)注的重要話題。本文以國家提出深化醫(yī)藥體制改革的意見的時間為節(jié)點(diǎn),運(yùn)用文獻(xiàn)分析、個案分析和統(tǒng)計分析三種方式方法,對奉化市醫(yī)保當(dāng)前的付費(fèi)方式和改革前的付費(fèi)方式進(jìn)行對比分析,同時回顧意見提出以后的改革經(jīng)過和歷史沿革。奉化市當(dāng)前的醫(yī)保付費(fèi)方式是總額預(yù)付制下,以按項(xiàng)目付費(fèi)等為補(bǔ)充的混合付費(fèi)方式,還建立了相關(guān)配套措施,比如家庭醫(yī)生,差別化支付等。與改革前相比,奉化市醫(yī)保付費(fèi)方式在控費(fèi)取得不錯的效果,但還是存在定額指標(biāo)不夠科學(xué)、人為干涉過多、未能夠?qū)Π床》N付費(fèi)引起足夠重視等問題。醫(yī)保付費(fèi)方式改革,既要符合基本醫(yī)療保險相符合定位,還要兼顧相關(guān)者的利益,注重社會影響。結(jié)合國內(nèi)外發(fā)達(dá)國家和地區(qū)普遍認(rèn)為付費(fèi)方式需要進(jìn)一步走向精細(xì)、科學(xué)、組合化的經(jīng)驗(yàn),筆者對奉化市醫(yī)保付費(fèi)方式提出了三方面具有針對性的建議:一是要堅持完善總額預(yù)付辦法,合理確定當(dāng)年度預(yù)算總額,可以考慮引入談判協(xié)商和指標(biāo)調(diào)整機(jī)制;二是進(jìn)一步探索混合付費(fèi)方式,同時完善付費(fèi)配套措施建設(shè);三是要加強(qiáng)對醫(yī)�；鸬念A(yù)算、支出、分析等工作,調(diào)整醫(yī)保報銷比例,避免出現(xiàn)基金結(jié)余過多或過少的問題。
[Abstract]:Medical insurance is mainly used to resist the medical risk caused by illness or injury, to reduce the phenomenon of illness to poverty or to return to poverty because of illness. However, the way of medical insurance payment not only ensures the proper expenditure of medical expenses, but also can control the quality of medical service. With the development of the society and the continuous improvement of people's health demand, excessive medical consumption is common, at the same time, it is difficult to see a doctor, and the expensive medical treatment is full of society, which has become a difficult problem to restrict the economic development. The reform of health insurance payment has become an important topic of social concern. Taking the time when the country put forward the suggestion of deepening the reform of the medical system as the node, using the three methods of literature analysis, case analysis and statistical analysis, this paper makes a comparative analysis of the current payment mode of medical insurance in Fenghua City and the payment method before the reform. At the same time, the review of the opinion proposed after the reform process and historical evolution. In Fenghua City, the current medical insurance payment method is a mixed payment method, which is supplemented by total prepaid system, such as item payment and so on, and has also established related supporting measures, such as family doctor, differential payment and so on. Compared with the reform before the reform, the medical insurance payment method in Fenghua City has achieved good results in controlling the fees, but there are still some problems, such as the quota index is not scientific enough, the artificial intervention is too much, and enough attention has not been paid to the payment according to the disease type. The reform of medical insurance payment not only accords with the orientation of basic medical insurance, but also pays attention to the interests of relevant parties and social impact. In combination with the experience that developed countries and regions at home and abroad generally believe that payment methods need to be further refined, scientific, and combined, The author puts forward three specific suggestions to Fenghua City: first, we should insist on perfecting the method of total prepayment, reasonably determine the total amount of budget for the current year, we can consider the mechanism of negotiation and index adjustment; Second, we should further explore the mixed payment method and improve the construction of supporting measures for payment. Third, we should strengthen the budget, expenditure and analysis of the medical insurance fund, adjust the proportion of medical insurance reimbursement, and avoid the problem of excessive or too little fund balance.
【學(xué)位授予單位】：寧波大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1;F842.684
本文編號：2149232
[Abstract]:Medical insurance is mainly used to resist the medical risk caused by illness or injury, to reduce the phenomenon of illness to poverty or to return to poverty because of illness. However, the way of medical insurance payment not only ensures the proper expenditure of medical expenses, but also can control the quality of medical service. With the development of the society and the continuous improvement of people's health demand, excessive medical consumption is common, at the same time, it is difficult to see a doctor, and the expensive medical treatment is full of society, which has become a difficult problem to restrict the economic development. The reform of health insurance payment has become an important topic of social concern. Taking the time when the country put forward the suggestion of deepening the reform of the medical system as the node, using the three methods of literature analysis, case analysis and statistical analysis, this paper makes a comparative analysis of the current payment mode of medical insurance in Fenghua City and the payment method before the reform. At the same time, the review of the opinion proposed after the reform process and historical evolution. In Fenghua City, the current medical insurance payment method is a mixed payment method, which is supplemented by total prepaid system, such as item payment and so on, and has also established related supporting measures, such as family doctor, differential payment and so on. Compared with the reform before the reform, the medical insurance payment method in Fenghua City has achieved good results in controlling the fees, but there are still some problems, such as the quota index is not scientific enough, the artificial intervention is too much, and enough attention has not been paid to the payment according to the disease type. The reform of medical insurance payment not only accords with the orientation of basic medical insurance, but also pays attention to the interests of relevant parties and social impact. In combination with the experience that developed countries and regions at home and abroad generally believe that payment methods need to be further refined, scientific, and combined, The author puts forward three specific suggestions to Fenghua City: first, we should insist on perfecting the method of total prepayment, reasonably determine the total amount of budget for the current year, we can consider the mechanism of negotiation and index adjustment; Second, we should further explore the mixed payment method and improve the construction of supporting measures for payment. Third, we should strengthen the budget, expenditure and analysis of the medical insurance fund, adjust the proportion of medical insurance reimbursement, and avoid the problem of excessive or too little fund balance.
【學(xué)位授予單位】：寧波大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1;F842.684
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