醫(yī)院內(nèi)部醫(yī)療保險混合支付方式的實施探討
發(fā)布時間：2018-09-15 05:39
【摘要】：目的通過比較江蘇省某三級甲等綜合性醫(yī)院內(nèi)部骨科和普外科醫(yī)保住院患者按混合支付方式付費與傳統(tǒng)按項目付費支付的實施效果，分析不同支付方式下醫(yī)�；颊哚t(yī)療費用、醫(yī)療質(zhì)量、服務(wù)效率、病人滿意度等指標(biāo)的變化和產(chǎn)生變化的原因，以期發(fā)現(xiàn)實施混合支付方式過程中需要改進(jìn)的問題，為提高醫(yī)療質(zhì)量、降低醫(yī)療費用、促進(jìn)衛(wèi)生資源的合理配置等提供依據(jù)。 材料與方法本研究選擇2011年7月1日-2012年6月30日期間骨科實施按混合支付方式付費的醫(yī)保住院病人500例為實驗組，實施傳統(tǒng)按項目付費支付的584例為對照組；普外科實施按混合支付方式付費的醫(yī)保住院病人1281例為實驗組，實施按項目付費支付的1123例為對照組。采用回顧性分析的方法，借助醫(yī)院信息系統(tǒng)收集相關(guān)病人的住院信息，對支付方式的實施效果進(jìn)行評價。效果評價指標(biāo)涉及工作效率、經(jīng)濟效率和績效評價等方面，對收集的數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析。 結(jié)果骨科和普外科實驗組和對照組醫(yī)�；颊咴谛詣e、年齡和入院情況等方面差異無統(tǒng)計學(xué)意義（P0.05）。兩個科實驗組相對于對照組住院總費用、藥品費用、材料費、床位費均下降，差異有統(tǒng)計學(xué)意義（P0.05）；治療費、護(hù)理費和治愈好轉(zhuǎn)率組間比較變化不大，差異無統(tǒng)計學(xué)意義（P0.05）；實驗組病人滿意度均高于對照組，差異有統(tǒng)計學(xué)意義（P0.05）。骨科實驗組檢查費低于對照組，差異有統(tǒng)計學(xué)意義（P0.05），普外科兩組間檢查費持平，差異無統(tǒng)計學(xué)意義（P0.05）。 結(jié)論醫(yī)療保險支付方式改革作為新醫(yī)改的重要內(nèi)容，是醫(yī)療保險過程中涉及各方經(jīng)濟利益最直接、最敏感的環(huán)節(jié)，對醫(yī)療服務(wù)的監(jiān)控和抑制過度醫(yī)療有著舉足輕重的作用。醫(yī)院內(nèi)部混合支付方式的實施能夠引導(dǎo)醫(yī)護(hù)人員規(guī)范診療行為，在保證醫(yī)療質(zhì)量的前提下降低醫(yī)療費用，減輕患者負(fù)擔(dān)，減少不必要的衛(wèi)生資源消耗，使住院費用構(gòu)成趨于合理化。
[Abstract]:Objective to compare the effect of medical expenses of medical insurance patients in general hospital of Grade 3A in Jiangsu Province by using mixed payment method and traditional payment by item payment method, and to analyze the medical cost of medical insurance patients under different payment methods. The changes of medical quality, service efficiency, patient satisfaction and the causes of the changes, in order to find out the problems that need to be improved in the process of implementing the mixed payment mode, in order to improve the quality of medical treatment and reduce the medical cost, To promote the rational allocation of health resources. Materials and methods from July 1, 2011 to June 30, 2012, 500 patients in orthopedic department were selected as experimental group and 584 patients as control group. In general surgery, 1281 medical inpatients paid for medical insurance were treated as experimental group and 1123 patients as control group. By means of retrospective analysis, the hospital information system was used to collect the inpatient information, and the effect of payment was evaluated. The data collected are statistically analyzed in the aspects of work efficiency, economic efficiency and performance evaluation. Results there was no significant difference in sex, age and admission between orthopaedic and general surgery groups and control group (P0.05). Compared with the control group, the total cost of hospitalization, drug cost, material cost, bed fee of the two experimental groups decreased significantly (P0.05), while the treatment cost, nursing cost and cure rate of the two groups did not change significantly (P0.05). The patients' satisfaction in the experimental group was higher than that in the control group, the difference was statistically significant (P0.05). The examination fee of orthopedic experimental group was lower than that of control group, the difference was statistically significant (P0.05), the examination fee of general surgery group was equal, the difference was not statistically significant (P0.05). Conclusion as an important part of the new medical reform, the reform of medical insurance payment mode is the most direct and sensitive link involving the economic interests of all parties in the process of medical insurance. It plays an important role in the monitoring of medical services and the suppression of excessive medical treatment. The implementation of the mixed payment method in hospital can lead the medical staff to standardize the diagnosis and treatment behavior, reduce the medical expenses, reduce the burden of the patients, and reduce the unnecessary consumption of health resources under the premise of ensuring the quality of medical treatment. Rationalize the composition of hospital expenses.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R197.3;F842.684
本文編號：2243937
[Abstract]:Objective to compare the effect of medical expenses of medical insurance patients in general hospital of Grade 3A in Jiangsu Province by using mixed payment method and traditional payment by item payment method, and to analyze the medical cost of medical insurance patients under different payment methods. The changes of medical quality, service efficiency, patient satisfaction and the causes of the changes, in order to find out the problems that need to be improved in the process of implementing the mixed payment mode, in order to improve the quality of medical treatment and reduce the medical cost, To promote the rational allocation of health resources. Materials and methods from July 1, 2011 to June 30, 2012, 500 patients in orthopedic department were selected as experimental group and 584 patients as control group. In general surgery, 1281 medical inpatients paid for medical insurance were treated as experimental group and 1123 patients as control group. By means of retrospective analysis, the hospital information system was used to collect the inpatient information, and the effect of payment was evaluated. The data collected are statistically analyzed in the aspects of work efficiency, economic efficiency and performance evaluation. Results there was no significant difference in sex, age and admission between orthopaedic and general surgery groups and control group (P0.05). Compared with the control group, the total cost of hospitalization, drug cost, material cost, bed fee of the two experimental groups decreased significantly (P0.05), while the treatment cost, nursing cost and cure rate of the two groups did not change significantly (P0.05). The patients' satisfaction in the experimental group was higher than that in the control group, the difference was statistically significant (P0.05). The examination fee of orthopedic experimental group was lower than that of control group, the difference was statistically significant (P0.05), the examination fee of general surgery group was equal, the difference was not statistically significant (P0.05). Conclusion as an important part of the new medical reform, the reform of medical insurance payment mode is the most direct and sensitive link involving the economic interests of all parties in the process of medical insurance. It plays an important role in the monitoring of medical services and the suppression of excessive medical treatment. The implementation of the mixed payment method in hospital can lead the medical staff to standardize the diagnosis and treatment behavior, reduce the medical expenses, reduce the burden of the patients, and reduce the unnecessary consumption of health resources under the premise of ensuring the quality of medical treatment. Rationalize the composition of hospital expenses.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R197.3;F842.684
【共引文獻(xiàn)】
相關(guān)碩士學(xué)位論文 前1條
1 王申娟;新農(nóng)村合作醫(yī)療的現(xiàn)狀、問題及對策研究[D];山西師范大學(xué);2012年
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