發(fā)布時間：2018-05-09 15:38

  本文選題：總額控制 + 經(jīng)濟(jì)運(yùn)行��； 參考：《廣西醫(yī)科大學(xué)》2016年碩士論文

【摘要】：背景：隨著我國深化醫(yī)藥衛(wèi)生體制改革步伐的不斷前進(jìn),公立醫(yī)院改革的問題日益突出,醫(yī)療費(fèi)用快速上漲,醫(yī)�；鹬С鲆�(guī)模的不斷膨脹,“看病難、看病貴”問題仍舊是阻礙我國社會經(jīng)濟(jì)發(fā)展的重大民生問題之一。支付方式改革作為公立醫(yī)院改革的重要環(huán)節(jié),對醫(yī)保費(fèi)用的控制起關(guān)鍵作用,目前我國各省市統(tǒng)籌地區(qū)都在積極探索控制費(fèi)用的支付方式改革,改革勢在必行。2013年,廣西壯族自治區(qū)對中區(qū)直駐邕單位職工基本醫(yī)療保險定點(diǎn)醫(yī)院進(jìn)行醫(yī)保付費(fèi)總額控制支付方式改革。目的：本研究通過對總額控制的設(shè)計方案和案例醫(yī)院的實(shí)施效果進(jìn)行研究,分析醫(yī)院執(zhí)行情況及應(yīng)對措施,評價該政策對醫(yī)院經(jīng)濟(jì)運(yùn)行尤其是醫(yī)療費(fèi)用、醫(yī)保費(fèi)用、次均費(fèi)用等方面的影響并探討其中存在的問題和產(chǎn)生問題的原因,為今后不斷完善醫(yī)保付費(fèi)總額控制政策提出合理化建議。方法：通過文獻(xiàn)研究和實(shí)地調(diào)查,歸納整理國內(nèi)外總額控制的相關(guān)理論以及評價醫(yī)院經(jīng)濟(jì)運(yùn)行的理論知識和分析方法。通過現(xiàn)場調(diào)研,對相關(guān)人員開展半結(jié)構(gòu)式訪談,了解總額控制方案的實(shí)施背景和執(zhí)行情況,收集2010-2013年間案例醫(yī)院就診患者相關(guān)數(shù)據(jù)和N市醫(yī)療保險基金基礎(chǔ)數(shù)據(jù)。運(yùn)用“結(jié)構(gòu)-行為-績效”分析方法對改革方案設(shè)計、醫(yī)院應(yīng)對管理措施和醫(yī)務(wù)人員認(rèn)知等方面進(jìn)行定性分析。運(yùn)用SPSS21.0統(tǒng)計軟件對數(shù)據(jù)進(jìn)行清洗和統(tǒng)計,綜合運(yùn)用假設(shè)檢驗(yàn)、中斷時間序列分析法和倍差法,從醫(yī)療服務(wù)量、工作效率、醫(yī)療費(fèi)用和醫(yī)療質(zhì)量四個維度,從改革前后醫(yī)院總體情況、職工醫(yī)保病人總體情況、職工醫(yī)保門診/住院病人情況和典型疾病組比較等四個層面來進(jìn)行數(shù)據(jù)分析,來評價實(shí)施醫(yī)保付費(fèi)總額控制對醫(yī)院經(jīng)濟(jì)運(yùn)行的影響。結(jié)果：醫(yī)保付費(fèi)總額控制政策實(shí)施后,定點(diǎn)醫(yī)院已經(jīng)形成控費(fèi)意識,醫(yī)�；鹬С龅脑鲩L趨勢逐漸回歸正常軌道。醫(yī)療服務(wù)量總體上漲,醫(yī)療服務(wù)效率不斷提高；醫(yī)療費(fèi)用快速上漲趨勢得到控制,但成效有限；醫(yī)保費(fèi)用在可控范圍內(nèi),基金運(yùn)行狀態(tài)良好；次均費(fèi)用增長速度下降,藥占比得到有效控制；醫(yī)院主動增強(qiáng)成本控制和醫(yī)療服務(wù)質(zhì)量管理。結(jié)論：醫(yī)保付費(fèi)總額控制支付方式具有一定的科學(xué)性與合理性,總額控制政策實(shí)施效果已初步顯現(xiàn)。但在政策實(shí)施過程中也存在著一些問題,為完善醫(yī)保付費(fèi)總額控制方案,提出以下建議：合理制定總控指標(biāo)測算模型和結(jié)算標(biāo)準(zhǔn)；完善大病保險政策,合并實(shí)施基本醫(yī)保和大病保險；加強(qiáng)醫(yī)院內(nèi)部運(yùn)行管理,落實(shí)科室責(zé)任；未來進(jìn)一步探索總控政策下的DRGs付費(fèi)方式。
[Abstract]:Background: with the continuous progress of deepening the reform of the medical and health system in our country, the problems of the reform of public hospitals are increasingly prominent, the medical expenses are rising rapidly, the scale of the medical insurance fund is expanding, "it is difficult to see a doctor," The problem of expensive medical treatment is still one of the major livelihood problems hindering the social and economic development of our country. As an important link in the reform of public hospitals, the reform of payment mode plays a key role in controlling the cost of medical insurance. At present, all provinces and cities in our country are actively exploring the reform of the payment mode of controlling expenses, and it is imperative to reform in 2013. Guangxi Zhuang Autonomous region has carried out the reform of the control and payment method of the total amount of medical insurance payment in the designated hospitals of basic medical insurance for the workers in the Central District of Guangxi. Objective: through the research on the design scheme of total amount control and the effect of the implementation of the case hospital, to analyze the hospital implementation and countermeasures, and to evaluate the policy to the hospital economic operation, especially the medical expenses, medical insurance costs. This paper discusses the problems and causes of the sub-average cost, and puts forward some reasonable suggestions for perfecting the policy of controlling the total amount of medical insurance payment in the future. Methods: through literature research and field investigation, the related theories of total amount control at home and abroad and the theoretical knowledge and analytical methods of evaluating hospital economic operation were summarized and sorted out. Through the field investigation, we conduct semi-structured interviews to the relevant personnel to understand the implementation background and implementation of the total control program, and collect the relevant data of patients in the case hospital from 2010 to 2013 and the basic data of the medical insurance fund of N city. The structural-behavioral-performance analysis method is used to analyze the reform scheme design, hospital management measures and medical staff cognition qualitatively. Using SPSS21.0 statistical software to clean and statistics the data, using hypothesis test, interrupt time series analysis and double difference method, from four dimensions of medical service quantity, work efficiency, medical cost and medical quality. The data are analyzed from four aspects: the general situation of hospitals before and after the reform, the general situation of employees' medical insurance patients, the outpatient / in-patient situation of workers' medical insurance, and the comparison of typical disease groups. To evaluate the impact of the implementation of total health insurance payment control on the economic operation of hospitals. Results: after the implementation of the policy of controlling the total amount of medical insurance payment, the consciousness of controlling the fee has been formed in the designated hospitals, and the increasing trend of the expenditure of the medical insurance fund has gradually returned to the normal track. The overall amount of medical services has risen, the efficiency of medical services has been continuously improved, the trend of rapid increase in medical costs has been controlled, but the results have been limited, the medical insurance costs are in a controllable range, the fund is in good condition, and the growth rate of sub-average costs has decreased. The ratio of drug to drug was effectively controlled, and the hospital actively enhanced cost control and medical service quality management. Conclusion: the method of controlling the total amount of medical insurance payment is scientific and reasonable, and the effect of the total amount control policy has been shown. However, there are still some problems in the process of implementing the policy. In order to improve the control scheme of the total amount of medical insurance payment, the following suggestions are put forward: the reasonable formulation of the calculation model and the settlement standard of the general control index, the improvement of the insurance policy for serious illness, The combination of basic medical insurance and serious illness insurance; strengthening the hospital internal operation management to implement the responsibility of the department; further explore the general control policy under the DRGs payment method in the future.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：F842.684

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