長沙市社會醫(yī)療保險混合支付方式研究
發(fā)布時間：2018-12-29 09:24
【摘要】：醫(yī)療費用的過快增長一直是制約我國衛(wèi)生事業(yè)發(fā)展的因素之一,為此,深化醫(yī)藥衛(wèi)生體制改革是大勢所趨,改革的內容涉及多個方面,其中,對于醫(yī)療保險支付方式的改革是當中的重點和難點�？v觀改革大勢,各地對醫(yī)療保險支付方式的改革呈現(xiàn)出多樣化。長沙市自2000年建立城鎮(zhèn)職工基本醫(yī)療保險制度以來,對于醫(yī)療保險支付方式的改革也在探索中前進,長沙市在醫(yī)療保險支付方式改革進程中取得了哪些成果?又存在哪些問題?如何突破現(xiàn)有的制度困境?這些問題都很值得研究,也具有一定的現(xiàn)實意義。本文就是以長沙市醫(yī)療保險支付方式改革作為切入點,具體探討長沙市在醫(yī)療保險支付方式改革進程中取得的成效和存在的問題,在此基礎上對長沙市支付方式未來的改革方向進行構建。 本文在對國內外文獻進行深入研究的基礎上,首先,對各種常見支付方式進行經(jīng)濟學分析,基于委托-代理理論提出預付制才是改革的正確方向；其次,基于對長沙市醫(yī)療保險事業(yè)發(fā)展的準確把握,具體分析長沙市醫(yī)療保險支付方式在改革進程中取得的成效和存在的問題；而后,通過借鑒國外典型國家和我國典型地區(qū)的醫(yī)療保險支付方式改革的經(jīng)驗,在此基礎上,提出長沙市醫(yī)療保險混合支付方式的構建思路。研究的主要結論如下： 1.長沙市在醫(yī)療保險支付方式改革過程中,取得的成效包括：醫(yī)療保險統(tǒng)籌基金運行平穩(wěn),醫(yī)療費用個人負擔的比例有所下降,醫(yī)生負擔病人情況逐步降低,同時采取按單病種付費之后,次均費用和住院天數(shù)均有所下降。 2.長沙市在醫(yī)療保險支付方式改革進程中,存在的問題包括：統(tǒng)籌基金支出的增長率高于收入增長率,單病種付費所占比例過小,在醫(yī)療費用中藥品費用所占比重過高,同時基層醫(yī)療機構的作用未充分體現(xiàn)。 3.長沙市醫(yī)療保險混合支付方式的構建：推行總額預付,繼續(xù)擴大按單病種付費,實行基本藥物目錄零差率銷售制度三個方面。
[Abstract]:The excessive growth of medical expenses has always been one of the factors restricting the development of health care in China. Therefore, deepening the reform of the medical and health system is the trend of the times. The content of the reform involves many aspects, among which, The reform of medical insurance payment is the key and difficult point. Throughout the general trend of reform, all over the medical insurance payment mode of reform presents diversification. Since the establishment of the basic medical insurance system for urban workers in Changsha in 2000, the reform of the payment mode of medical insurance is also in the process of exploration. What achievements have been made in the reform of the medical insurance payment mode in Changsha? What are the problems? How to break through the existing system dilemma? These problems are very worthy of study, but also have certain practical significance. This paper, taking the reform of medical insurance payment mode in Changsha as the starting point, specifically discusses the achievements and existing problems in the process of medical insurance payment reform in Changsha. On the basis of this, the future reform direction of payment mode in Changsha is constructed. Based on the in-depth study of domestic and foreign literature, this paper first of all, the economic analysis of a variety of common payment methods, based on the principal-agent theory is the correct direction of the reform of the prepayment system; Secondly, based on the accurate understanding of the development of medical insurance in Changsha, the paper analyzes the effect and problems of the medical insurance payment in Changsha. Then, based on the experience of medical insurance payment reform in typical countries and regions of China, this paper puts forward the construction idea of mixed payment mode of medical insurance in Changsha. The main conclusions are as follows: 1. In the course of the reform of the medical insurance payment system in Changsha City, the results have included: the smooth operation of the medical insurance overall planning fund, the decrease in the proportion of individual burdens for medical expenses, and the gradual decrease in the burden on patients by doctors. At the same time, the average fee and the number of days in hospital decreased after the single-disease payment. 2. In the process of medical insurance payment reform in Changsha, the existing problems include: the growth rate of overall fund expenditure is higher than the income growth rate, the proportion of single-disease payment is too small, and the proportion of drug expenditure in medical expenses is too high. At the same time, the role of primary medical institutions is not fully reflected. 3. The construction of mixed payment method of medical insurance in Changsha city: carry out total advance, continue to expand the payment by single disease, and implement the zero difference sales system of essential drugs catalogue.
【學位授予單位】：湖南大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：F842.684
本文編號：2394652
[Abstract]:The excessive growth of medical expenses has always been one of the factors restricting the development of health care in China. Therefore, deepening the reform of the medical and health system is the trend of the times. The content of the reform involves many aspects, among which, The reform of medical insurance payment is the key and difficult point. Throughout the general trend of reform, all over the medical insurance payment mode of reform presents diversification. Since the establishment of the basic medical insurance system for urban workers in Changsha in 2000, the reform of the payment mode of medical insurance is also in the process of exploration. What achievements have been made in the reform of the medical insurance payment mode in Changsha? What are the problems? How to break through the existing system dilemma? These problems are very worthy of study, but also have certain practical significance. This paper, taking the reform of medical insurance payment mode in Changsha as the starting point, specifically discusses the achievements and existing problems in the process of medical insurance payment reform in Changsha. On the basis of this, the future reform direction of payment mode in Changsha is constructed. Based on the in-depth study of domestic and foreign literature, this paper first of all, the economic analysis of a variety of common payment methods, based on the principal-agent theory is the correct direction of the reform of the prepayment system; Secondly, based on the accurate understanding of the development of medical insurance in Changsha, the paper analyzes the effect and problems of the medical insurance payment in Changsha. Then, based on the experience of medical insurance payment reform in typical countries and regions of China, this paper puts forward the construction idea of mixed payment mode of medical insurance in Changsha. The main conclusions are as follows: 1. In the course of the reform of the medical insurance payment system in Changsha City, the results have included: the smooth operation of the medical insurance overall planning fund, the decrease in the proportion of individual burdens for medical expenses, and the gradual decrease in the burden on patients by doctors. At the same time, the average fee and the number of days in hospital decreased after the single-disease payment. 2. In the process of medical insurance payment reform in Changsha, the existing problems include: the growth rate of overall fund expenditure is higher than the income growth rate, the proportion of single-disease payment is too small, and the proportion of drug expenditure in medical expenses is too high. At the same time, the role of primary medical institutions is not fully reflected. 3. The construction of mixed payment method of medical insurance in Changsha city: carry out total advance, continue to expand the payment by single disease, and implement the zero difference sales system of essential drugs catalogue.
【學位授予單位】：湖南大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：F842.684
【參考文獻】
相關期刊論文 前10條
1 劉君;何夢喬;;醫(yī)療保險混合支付方式研究[J];保險研究;2010年07期
2 梁春賢;;我國醫(yī)療保險費用支付方式問題的探討[J];財政研究;2007年08期
3 韓俊江;胡丹;;創(chuàng)新醫(yī)保支付方式化解“看病貴”探析——以長春市醫(yī)療保險支付方式改革為例[J];東北師大學報(哲學社會科學版);2012年02期
4 李曉暉;劉啟明;;社會醫(yī)療保險中混合式醫(yī)療費用支付方式的探索[J];河南大學學報(社會科學版);2011年03期
5 趙一夫,楊經(jīng)福;淺析信息不對稱導致的道德風險問題[J];經(jīng)濟師;2001年06期
6 崔怡瑩;;城鎮(zhèn)職工基本醫(yī)療保險三種付費方式的比較——以天津市為例[J];內蒙古科技與經(jīng)濟;2010年21期
7 趙穎旭;;美國醫(yī)療照顧制度的主要醫(yī)療服務支付方式介紹[J];中國全科醫(yī)學;2012年28期
8 陳暉;劉宗龍;;世界各國醫(yī)療保險支付方式之比較分析[J];天津社會保險;2012年05期
9 董文勇;;德國社會醫(yī)療保險用藥費用控制制度及其對中國的啟示[J];環(huán)球法律評論;2006年02期
10 蘇榕生;張仰龍;李進亮;;混合支付方式是新型農村合作醫(yī)療的合理選擇[J];衛(wèi)生經(jīng)濟研究;2006年08期
，本文編號：2394652
本文鏈接：http://sikaile.net/jingjilunwen/bxjjlw/2394652.html
最近更新
教材專著
