【摘要】：改革開放以來我國(guó)醫(yī)藥衛(wèi)生體制改革已經(jīng)走過了30多年的歷程,在我國(guó)的醫(yī)藥衛(wèi)生體制中,醫(yī)院是聯(lián)結(jié)政府、醫(yī)保、藥品供應(yīng)、社區(qū)醫(yī)療衛(wèi)生與群眾的紐帶,改革的許多政策都要通過醫(yī)院來實(shí)現(xiàn)。縣級(jí)公立醫(yī)院是縣級(jí)行政區(qū)域內(nèi)醫(yī)療衛(wèi)生服務(wù)體系的龍頭和主體,是當(dāng)前醫(yī)改的重點(diǎn)和難點(diǎn)[1]。2009年,我國(guó)新醫(yī)改正式拉開序幕,公立醫(yī)院補(bǔ)償機(jī)制改革作為新醫(yī)改的主要任務(wù)之一,正式提到了醫(yī)改的議事日程。2013年,以破除“以藥補(bǔ)醫(yī)”機(jī)制為關(guān)鍵環(huán)節(jié),以改革補(bǔ)償機(jī)制為切入點(diǎn),我國(guó)在311個(gè)試點(diǎn)縣市全面推開縣級(jí)公立醫(yī)院綜合改革�？h級(jí)公立醫(yī)院綜合改革是從改革補(bǔ)償機(jī)制入手,即取消藥品加成、完善政府財(cái)政補(bǔ)償、調(diào)整醫(yī)療服務(wù)價(jià)格。以改革補(bǔ)償機(jī)制為前提的改革必將會(huì)影響醫(yī)院的經(jīng)濟(jì)運(yùn)行狀況,進(jìn)而影響醫(yī)院未來的發(fā)展。本研究通過對(duì)山東省縣級(jí)公立醫(yī)院補(bǔ)償機(jī)制改革前后醫(yī)院經(jīng)濟(jì)運(yùn)行狀況進(jìn)行比較分析和探討,為醫(yī)院的可持續(xù)發(fā)展提供理論和實(shí)踐依據(jù)。本研究闡述了公立醫(yī)院補(bǔ)償機(jī)制改革的相關(guān)理論基礎(chǔ),梳理了公立醫(yī)院補(bǔ)償機(jī)制的相關(guān)概念及模式,介紹了縣級(jí)公立醫(yī)院補(bǔ)償機(jī)制改革與發(fā)展的基本內(nèi)容。通過山東省縣級(jí)公立醫(yī)院綜合改革監(jiān)測(cè)網(wǎng),收集本研究所需要的定量及定性資料,通過excel軟件進(jìn)行數(shù)據(jù)的錄入和整理。采用正態(tài)性檢驗(yàn)、方差齊性檢驗(yàn)、T檢驗(yàn)、Mann-Whitney u檢驗(yàn)以及描述性統(tǒng)計(jì)方法分析補(bǔ)償機(jī)制改革前后縣級(jí)公立醫(yī)院經(jīng)濟(jì)運(yùn)行狀況。通過樣本縣級(jí)公立醫(yī)院相關(guān)數(shù)據(jù)的處理分析,縣級(jí)公立醫(yī)院補(bǔ)償機(jī)制改革的成效和問題并存,醫(yī)院財(cái)政補(bǔ)助收入增長(zhǎng)明顯,但占醫(yī)院總收入的比重仍較低,藥品收入所占比重有較大幅度的下降。公立醫(yī)院補(bǔ)償機(jī)制改革對(duì)縣級(jí)公立醫(yī)院經(jīng)濟(jì)效益產(chǎn)生明顯的影響,但醫(yī)院服務(wù)效率未明顯改善。補(bǔ)償機(jī)制改革存在一定的時(shí)間效應(yīng),短期效果并沒有顯著性差異,仍需要進(jìn)一步研究。
[Abstract]:More than 30 years have passed since the reform and opening up of China's medical and health system. In the medical and health system of our country, hospitals are the link between the government, medical insurance, drug supply, community medical and health care and the masses. Many of the policies of the reform have to be implemented through hospitals. The county-level public hospitals are the leading and main body of the medical and health service system in the county-level administrative regions, and are the key and difficult points of the current medical reform [1]. In 2009, the new medical reform of our country officially kicked off. As one of the main tasks of the new medical reform, the reform of the compensation mechanism in public hospitals has been formally mentioned in the agenda of the medical reform. In 2013, the key link was to break the mechanism of "taking medicine as a supplement", and the reform of the compensation mechanism was regarded as the starting point. In 311 pilot counties and cities, comprehensive reform of county-level public hospitals has been fully promoted. The comprehensive reform of county-level public hospitals begins with the reform of compensation mechanism, that is, the cancellation of drug addition, the improvement of government financial compensation, and the adjustment of medical service prices. The reform on the premise of reforming the compensation mechanism will affect the economic operation of the hospital and then affect the future development of the hospital. Through the comparative analysis and discussion on the economic operation of the hospitals before and after the reform of the compensation mechanism of the county-level public hospitals in Shandong Province, this study provides a theoretical and practical basis for the sustainable development of hospitals. This paper expounds the theoretical basis of the public hospital compensation mechanism reform, combs the relevant concepts and models of the public hospital compensation mechanism, and introduces the basic content of the county level public hospital compensation mechanism reform and development. Through the comprehensive reform monitoring network of county-level public hospitals in Shandong Province, the quantitative and qualitative data needed in this study were collected, and the data input and collation were carried out by excel software. The normal test, variance homogeneity test and Mann-Whitney u test were used to analyze the economic operation of county-level public hospitals before and after the reform of compensation mechanism. Through the processing and analysis of the sample data of county-level public hospitals, the results and problems of the compensation mechanism reform of county-level public hospitals coexist, and the financial subsidy income of hospitals increases obviously, but the proportion of total hospital income is still relatively low. The proportion of drug income has decreased by a large margin. The reform of compensation mechanism of public hospitals has a significant impact on the economic benefits of county-level public hospitals, but the efficiency of hospital services has not been significantly improved. There is a certain time effect in the reform of compensation mechanism, but there is no significant difference in the short-term effect.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R197.322

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