【摘要】：醫(yī)保主要用于抵御因患病或傷害帶來的醫(yī)療風險,減少因病至貧或因病返貧現(xiàn)象,而醫(yī)保付費方式不僅保障醫(yī)療費用支出恰當合理,還可以控制醫(yī)療服務質量。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)濟發(fā)展的難題。醫(yī)保付費方式改革已經(jīng)成為社會關注的重要話題。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,運用文獻分析、個案分析和統(tǒng)計分析三種方式方法,對奉化市醫(yī)保當前的付費方式和改革前的付費方式進行對比分析,同時回顧意見提出以后的改革經(jīng)過和歷史沿革。奉化市當前的醫(yī)保付費方式是總額預付制下,以按項目付費等為補充的混合付費方式,還建立了相關配套措施,比如家庭醫(yī)生,差別化支付等。與改革前相比,奉化市醫(yī)保付費方式在控費取得不錯的效果,但還是存在定額指標不夠科學、人為干涉過多、未能夠對按病種付費引起足夠重視等問題。醫(yī)保付費方式改革,既要符合基本醫(yī)療保險相符合定位,還要兼顧相關者的利益,注重社會影響。結合國內外發(fā)達國家和地區(qū)普遍認為付費方式需要進一步走向精細、科學、組合化的經(jīng)驗,筆者對奉化市醫(yī)保付費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付辦法,合理確定當年度預算總額,可以考慮引入談判協(xié)商和指標調整機制;二是進一步探索混合付費方式,同時完善付費配套措施建設;三是要加強對醫(yī)�；鸬念A算、支出、分析等工作,調整醫(yī)保報銷比例,避免出現(xiàn)基金結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.
【學位授予單位】：寧波大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.1;F842.684

【參考文獻】

相關期刊論文 前1條

1 姚宏;;事關醫(yī)改全局的兩件大事——推進門診統(tǒng)籌和付費方式改革的基本思路[J];中國醫(yī)療保險;2011年07期

相關碩士學位論文 前4條

1 勞佳奇;新醫(yī)改下的杭州市基本醫(yī)療保險支付方式改革研究[D];浙江財經(jīng)大學;2014年

2 焦裕斌;醫(yī)療保險付費方式研究[D];山東師范大學;2013年

3 劉真;我國醫(yī)療保險付費方式研究[D];山東師范大學;2012年

4 張毅;淄博市城鎮(zhèn)職工基本醫(yī)療保險付費方式改革探析[D];中國海洋大學;2011年

，

本文編號：2149232