本文關(guān)鍵詞： 醫(yī)療保險 新型農(nóng)村合作醫(yī)療 按病種付費 雙重差分模型　出處：《中國科學(xué)技術(shù)大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：在我國當(dāng)前的醫(yī)療保險制度下,"看病難,看病貴"一直是全國民眾和各類相關(guān)機構(gòu)所頭疼的問題。醫(yī)療服務(wù)費用的增加,進而會增加病患的經(jīng)濟負擔(dān),從而會進一步惡化當(dāng)前的醫(yī)患關(guān)系。想要提高全民的醫(yī)療保障水平,促使我國醫(yī)療保障制度進一步完善,以醫(yī)療費用支付方式為切入點進行醫(yī)療保障制度改革是當(dāng)前醫(yī)療改革的重要一環(huán)。目前我國新型農(nóng)村合作醫(yī)療的發(fā)展面臨著要以較低的籌資水平來提高醫(yī)療保障水平的挑戰(zhàn)。按病種付費機制是一項以病種分組和定價為技術(shù)核心的醫(yī)療保險支付方式,根據(jù)國際經(jīng)驗顯示,按病種付費機制可以有效控制不合理的醫(yī)療費用增長,同時還能在提高醫(yī)療服務(wù)質(zhì)量和效率等方面能夠發(fā)揮積極作用。我國在新型農(nóng)村合作醫(yī)療制度建立以及推廣初期就開始積極探索和實施按病種付費機制改革。安徽省新農(nóng)合作為我國新農(nóng)合的重要成員,當(dāng)前其醫(yī)保基金已經(jīng)面臨透支的風(fēng)險,原定的給醫(yī)療機構(gòu)以定額補貼的補償方式面臨著嚴(yán)峻考驗,各類補貼定額是否合理、醫(yī)保基金是否存在浪費這一系列問題亟待解決。根據(jù)安徽省新農(nóng)合所面臨的問題,本研究以安徽省縣級行政區(qū)醫(yī)療機構(gòu)為研究對象,運用文獻分析、描述性統(tǒng)計分析、雙重差分模型以及穩(wěn)健性檢驗等工具,首先對當(dāng)前安徽省新農(nóng)合目前實行按病種付費的方式進行了分析。目前安徽省新農(nóng)合實施的按病種付費機制的一項具體手段是自己編制一套新的疾病代碼系統(tǒng),并與國際上通用的ICD-10編碼構(gòu)成一一對應(yīng)的關(guān)系,并以新的編碼系統(tǒng)作為執(zhí)行按病種付費機制的基準(zhǔn)。其次,本研究在此基礎(chǔ)上分析了按病種付費機制對安徽省縣級行政區(qū)域醫(yī)療機構(gòu)的醫(yī)療服務(wù)費用的影響情況,并得出定量的研究結(jié)果。在此之后,本研究對當(dāng)前的研究結(jié)果進行了檢驗,得出對于不同疾病,按病種付費機制會有不同的效果。最后,本研究給出了當(dāng)前研究的拓展方向,并給出新農(nóng)合改進按病種付費機制的相關(guān)建議。
[Abstract]:Under the current medical insurance system of our country, "difficult to see a doctor, expensive to see a doctor" has always been a headache for the people of the whole country and all kinds of related institutions. The increase in the cost of medical services will increase the economic burden of patients. This will further worsen the current doctor-patient relationship. Want to improve the level of medical security of the whole people, promote the further improvement of our medical security system. The reform of medical security system based on the payment of medical expenses is an important part of the current medical reform. At present, the development of the new rural cooperative medical system in China is facing the need to raise medical security at a lower level of financing. The payment mechanism by disease category is a medical insurance payment method with disease grouping and pricing as the core technology. According to international experience, the mechanism of paying for diseases can effectively control the unreasonable increase of medical costs. At the same time, it can also play a positive role in improving the quality and efficiency of medical service. Our country has been actively exploring and implementing the reform of the payment mechanism according to disease in the early stage of establishing and popularizing the new rural cooperative medical system. Huizhou New Rural Cooperation is an important member of China's New Rural Cooperation (NCMS). At present, its health insurance fund has been faced with the risk of overdraft, the original compensation to medical institutions with quota is facing a severe test, all kinds of subsidy quota is reasonable. According to the problems faced by the New Rural Cooperation in Anhui Province, this study takes the medical institutions of the county-level administrative region of Anhui Province as the research object, using literature analysis. Descriptive statistical analysis, double difference model and robustness test. First of all, this paper analyzes the current implementation of the new agricultural cooperation in Anhui Province according to the disease payment method. At present, a specific means of Anhui new agricultural cooperation by disease payment mechanism is to compile a new disease code system. And with the international common ICD-10 coding form a one-to-one correspondence, and the new coding system as the implementation of the payment mechanism by disease benchmark. Secondly. On this basis, this study analyzed the effect of the disease payment mechanism on the medical service cost of the county administrative medical institutions in Anhui province, and obtained the quantitative research results. In this study, the current research results are tested, and it is concluded that the pay mechanism according to disease will have different effects for different diseases. Finally, this study gives the development direction of the current research. It also gives some suggestions on how to improve the payment mechanism by disease.
【學(xué)位授予單位】：中國科學(xué)技術(shù)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1;F842.684

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