發(fā)布時間：2018-06-08 08:18

  本文選題：藥品零差率銷售政策 + 醫(yī)療費用��； 參考：《福建農(nóng)林大學》2017年碩士論文

【摘要】：長期以來,"看病難"、"看病貴"都是困擾群眾生活的一個重要問題。而藥價過高問題是農(nóng)民"看病貴"的一個重要原因,且大多數(shù)農(nóng)村患者的醫(yī)藥支付方式為新農(nóng)合,門診報銷的比例較低,農(nóng)民"因病致貧、因病返貧"的現(xiàn)象屢有發(fā)生。我國自2009年開始以試點形式在全國范圍內(nèi)開展藥品零差率銷售政策,通過以"藥改"的方式推動"醫(yī)改",促使整個醫(yī)療體系的改革。當前,醫(yī)療費用的不斷上升,引起了越來越多人的關注,本文對藥品零差率銷售政策的實施對醫(yī)療費用支出的影響展開研究。本文通過對國家基本藥物制度和福建省基本藥品零差率銷售相關政策的梳理,旨在分析實行藥品零差率后對醫(yī)療機構(gòu)藥品價格的影響情況以及對農(nóng)村患者醫(yī)療費用負擔的影響,并且對當前福建省的藥品零差率實施的可行性進行判斷研究,為進一步完善基本藥品零差率銷售及相關政策提供客觀依據(jù)。本文參考了大量文獻研究采用統(tǒng)計學分析法對福州市2009-2015年的新農(nóng)合醫(yī)保病例醫(yī)療費用的數(shù)據(jù),構(gòu)建農(nóng)村患者次均門診費用的時間序列預測模型;通過抽樣調(diào)查農(nóng)村居民年醫(yī)療費用支出情況,結(jié)合醫(yī)療費用支出的多種影響因素建立面板數(shù)據(jù)多元回歸線性模型。研究結(jié)果表明:藥品零差率銷售政策的實施在控制藥品價格上漲上取得一定的成效,藥占比有下降的趨勢,但是對于農(nóng)村患者的次均門診費用沒有起到降低的效果。藥品零差率政策與農(nóng)村居民醫(yī)療費用負擔存在正相關,說明藥品零差率銷售政策實施后沒有減輕農(nóng)村居民的醫(yī)療費用負擔。經(jīng)過討論分析,發(fā)現(xiàn)在取消藥品加成率的同時也提高了醫(yī)療服務的費用,導致農(nóng)村居民實際醫(yī)療費用支出沒有下降。本研究對此提出了政策建議,推動城市優(yōu)質(zhì)醫(yī)療衛(wèi)生資源向基層延伸,提高農(nóng)村居民收入;完善補償機制,只有提高政府投入才能有效保障醫(yī)療機構(gòu)的政策運行,減少醫(yī)生、醫(yī)院對藥品收入的依賴;正確引導和推進藥品零差率政策的實施,需要建立起一個完善的監(jiān)督管理體制,才能有效保障醫(yī)療機構(gòu)衛(wèi)生服務事業(yè)健康有序地發(fā)展;完善醫(yī)保支付體制改革,建立醫(yī)療保險項目的價格體系。
[Abstract]:For a long time, "difficult to see a doctor" and "expensive to see a doctor" have been an important problem puzzling people's life. The problem of high drug price is an important reason for farmers to "see a doctor expensive", and most rural patients' medical payment method is the new rural cooperative, the proportion of outpatient reimbursement is low, the phenomenon of farmers "poor because of illness, return to poverty because of illness" often occurs. Since 2009, our country began to carry out the policy of zero difference rate of drug sales in the whole country in the form of pilot in 2009, and promote the reform of the whole medical system through the way of "drug reform". At present, more and more people pay more and more attention to the rising medical expenses. This paper studies the effect of the implementation of the zero difference rate of drug sales policy on medical expenses. By combing the national essential drug system and the related policies of Fujian Province, this paper aims to analyze the influence of the implementation of the zero difference rate on the drug prices of medical institutions and the impact on the burden of medical expenses of rural patients. And the feasibility of the implementation of drug zero difference rate in Fujian Province is judged and studied, which provides an objective basis for the further improvement of the sales of essential drugs and related policies. Referring to a large number of literature studies, this paper uses statistical analysis method to analyze the medical expenses of new rural cooperative medical insurance cases from 2009 to 2015 in Fuzhou, and constructs a time series prediction model of rural patients' outpatient expenditure. A multivariate regression linear model of panel data was established by sampling the annual medical expenditure of rural residents and combining with various influencing factors of medical expenditure. The results show that the implementation of the policy of zero difference rate of drug sales has achieved some results in controlling the increase of drug prices, and the proportion of drugs has a downward trend, but the average outpatient expenses of rural patients have not been reduced. There was a positive correlation between the policy of zero difference rate of drugs and the burden of medical expenses of rural residents, which indicated that the implementation of the policy of zero difference rate of drugs sales did not reduce the burden of medical expenses of rural residents. After discussion and analysis, it is found that the cost of medical service is increased while the drug addition rate is cancelled, which leads to the fact that the actual medical expenses of rural residents have not decreased. This study puts forward some policy suggestions to promote the urban high-quality medical and health resources to extend to the grass-roots level, to improve the income of rural residents, to improve the compensation mechanism, only by increasing government input to effectively ensure the policy operation of medical institutions and reduce the number of doctors. It is necessary to establish a perfect supervision and management system to ensure the healthy and orderly development of health service in medical institutions. We will improve the reform of the medical insurance payment system and establish a price system for medical insurance items.
【學位授予單位】：福建農(nóng)林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R95

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本文編號：1995309