本文選題：城市公立醫(yī)院 + 醫(yī)療服務(wù)價格�。� 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景自2009年新醫(yī)改啟動以來,公立醫(yī)院補償機制改革、醫(yī)療服務(wù)價格形成機制改革已逐步成為醫(yī)改的核心任務(wù),國家先后出臺若干文件,各地也在不斷進行試點改革。2012年開始,我國加快推進公立醫(yī)院醫(yī)藥價格改革。2016年7月,國家發(fā)改委等四部門聯(lián)合印發(fā)《關(guān)于推進醫(yī)療服務(wù)價格改革意見的通知》(發(fā)改價格(2016]1431號)文件提出,我國將按照“總量控制、結(jié)構(gòu)調(diào)整、有升有降、逐步到位”的要求,全面推進醫(yī)療服務(wù)價格改革,由此掀起新一輪醫(yī)療服務(wù)價格改革熱潮。目前,全國部分省市如北京、上海、江蘇、安徽等已走在醫(yī)療服務(wù)價格改革前列,廣東省僅有深圳、中山、東莞、珠海開展試點工作。盡管廣東省在深化醫(yī)療服務(wù)價格改革中取得積極成效,但醫(yī)療服務(wù)價格尚未理順、管理方式仍需改進、價格行為有待進一步規(guī)范。因此,本研究全面梳理相關(guān)定價理論和定價方法,根據(jù)國家有關(guān)醫(yī)療服務(wù)價格改革文件精神要求,借鑒國外先進的做法及我國已進行醫(yī)療價格改革省市的經(jīng)驗,在對廣東省駐穗省屬、部屬、軍隊醫(yī)院近三年經(jīng)濟基礎(chǔ)數(shù)據(jù)進行收集和分析的基礎(chǔ)上,研究廣東省城市公立醫(yī)院醫(yī)療服務(wù)價格調(diào)整原則、調(diào)整范圍、調(diào)整幅度,構(gòu)建醫(yī)療服務(wù)價格調(diào)整模型,測算并實證分析醫(yī)療服務(wù)價格調(diào)整方案,提出相應(yīng)的政策建議,為理順廣東省醫(yī)療服務(wù)價格比價關(guān)系、推進醫(yī)療服務(wù)價格改革提供決策支持。研究方法本課題采用的研究方法包括:文獻資料法、問卷調(diào)查法、描述性統(tǒng)計分析法、對比分析法、專家咨詢法、實證分析法。研究結(jié)果1.醫(yī)療服務(wù)價格調(diào)整方案:在測算價格調(diào)整總盤的基礎(chǔ)上,根據(jù)價格理論、價格政策、各省市價格調(diào)整方案、本次醫(yī)療服務(wù)價格調(diào)整原則和調(diào)整范圍,共設(shè)計A、B兩套醫(yī)療服務(wù)價格調(diào)整方案。其中,A、B兩套方案中,各分別設(shè)計三套子方案,即A-1、A-2、A-3、B-1、B-2、B-3。以方案A-1為例:(1)取消藥品加成額和耗材加成額的80%;(2)醫(yī)學(xué)影像、核醫(yī)學(xué)、檢驗(臨床微生物學(xué)檢查除外)項目價格在現(xiàn)有基礎(chǔ)上降低8%;(3)綜合醫(yī)療服務(wù)類項目價格在現(xiàn)有基礎(chǔ)上提高34%;(4)臨床各系統(tǒng)診療、手術(shù)治療、物理治療與康復(fù)、中醫(yī)及民族醫(yī)診療類項目價格在現(xiàn)有基礎(chǔ)上提高30%;(5)病理檢查(分子病理學(xué)診斷技術(shù)除外)項目價格在現(xiàn)有基礎(chǔ)上提高9%;(6)超聲檢查、放射治療、血型與配血、經(jīng)血管介入診療項目不調(diào)價。2.醫(yī)療服務(wù)價格調(diào)整方案具有合理性和可行性。10家醫(yī)院實證結(jié)果顯示,方案A-1、A-2、A-3、B-1、B-2、B-3“醫(yī)療服務(wù)價格調(diào)整前后比值”均值分別為 100.71%、100.72%、100.66%、100.78%、100.91%、100.94%,均在 95%-105%的合理區(qū)間內(nèi)。政策建議1.價格調(diào)整一次到位;2.采用上海、江蘇模式;3.醫(yī)療服務(wù)價格高于廣東省已改革試點城市;4.建立動態(tài)價格評價與調(diào)價機制;5.逐步對接和實施2012年版;6.推進藥品、耗材流通領(lǐng)域改革;7.建立預(yù)警機制和應(yīng)急基金。
[Abstract]:Since the new medical reform was launched in 2009, the reform of compensation mechanism in public hospitals and the reform of price formation mechanism of medical services have gradually become the core task of the medical reform. Various localities are also continuing to carry out pilot reforms. Since 2012, China has accelerated the reform of pharmaceutical prices in public hospitals. In July 2016, The National Development and Reform Commission and other four departments jointly issued the notice on promoting the Reform of the prices of Medical Services (No. 1431), which states that China will follow the requirements of "total volume control, structural adjustment, rise and fall, step by step". Promote the reform of medical service price in an all-round way, thus set off a new wave of reform of medical service price. At present, some provinces and cities in China, such as Beijing, Shanghai, Jiangsu, Anhui, etc., have been in the forefront of medical service price reform, Guangdong Province only Shenzhen, Zhongshan, Dongguan, Zhuhai to carry out pilot work. Although Guangdong Province has achieved positive results in deepening the reform of medical service prices, the price of medical services has not yet been straightened out, the management mode still needs to be improved, and the price behavior needs to be further standardized. Therefore, this research comprehensively combs the related pricing theory and the pricing method, according to the national related medical service price reform document spirit request, draws lessons from the foreign advanced practice and our country has carried on the medical price reform province and city experience, On the basis of the collection and analysis of the data of the economic base of Guangdong Province in Guangzhou over the past three years, the adjustment principles, the scope and the range of adjustment of the medical service prices of the municipal public hospitals in Guangdong Province have been studied. This paper constructs a model of medical service price adjustment, calculates and empirically analyzes the adjustment scheme of medical service price, puts forward corresponding policy recommendations, and provides decision support for straightening out the relationship between medical service price and price ratio in Guangdong Province and promoting the reform of medical service price. The research methods used in this paper include: literature method, questionnaire survey, descriptive statistical analysis, comparative analysis, expert consultation, and empirical analysis. Results 1. Medical service price adjustment scheme: on the basis of calculating the total price adjustment, according to the price theory, price policy, provincial and municipal price adjustment plan, the principle and scope of this medical service price adjustment, Two sets of medical service price adjustment schemes were designed. In each of the two sets of schemes, three sets of schemes are designed, namely, A-1C, A-2N, A-3N, B-1, B-2, and B-3, respectively. Take scenario A-1 as an example: 1) canceling 80% of the addition of drugs and consumables) Medical imaging, nuclear medicine, The item price of examination (except clinical microbiology examination) is reduced by 8% on the existing basis) the price of comprehensive medical service item increases 34% on the existing basis) the diagnosis and treatment, surgical treatment, physiotherapy and rehabilitation of clinical system, The price of diagnostic and therapeutic items of traditional Chinese medicine and ethnic medicine is increased by 30% on the existing basis) pathological examination (except molecular pathological diagnosis technology) item price is increased by 9% on the existing basis) ultrasonic examination, radiation therapy, blood type and blood matching, The item of transvascular interventional diagnosis and treatment is not adjusted. 2. The results of the empirical study in 10 hospitals showed that the average value of the price adjustment scheme A-1 / A / B / B / B / B / B / B 3 was 100.71 / 100.77 / 100.66 / 100.78 / 100.941 / 100.94, respectively, which was in the reasonable range of 95-105%. The average value of the scheme was 100.71 / 100.66 / 100.78 / 100.941 / 100.94, respectively, in the reasonable range of 95-105%. Policy recommendation 1. Price adjustment once in place. Adopt Shanghai and Jiangsu model. The price of medical services is higher than that of Guangdong Province's reformed pilot city of 4. 4%. Establish dynamic price evaluation and price adjustment mechanism. Step by step docking and implementation of the 2012 version of 6. Promoting the reform in the field of circulation of pharmaceuticals and consumables. Establish early warning mechanism and contingency fund.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1

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