本文選題：精神分裂癥 + 門診特殊疾病�。� 參考：《華中科技大學(xué)》2012年碩士論文

【摘要】：研究目的 在了解精神分裂癥門診患者醫(yī)療衛(wèi)生服務(wù)利用情況、醫(yī)療費(fèi)用負(fù)擔(dān)狀況、醫(yī)保政策補(bǔ)償情況的基礎(chǔ)上，討論分析當(dāng)前門診醫(yī)療服務(wù)利用存在的問題以及醫(yī)保補(bǔ)償方式對患者醫(yī)療費(fèi)用支出、就醫(yī)行為和基金運(yùn)行的影響，論證精神分裂癥納入門診特殊疾病統(tǒng)籌的必要性，以及門診特殊疾病統(tǒng)籌制度補(bǔ)償方式的各項(xiàng)決策的合理性，繼而提出更具有針對性的醫(yī)療保險(xiǎn)補(bǔ)償方式政策建議。 研究方法 通過回顧性數(shù)據(jù)調(diào)查法、典型問卷調(diào)查、知情人訪談等方式獲取四個(gè)地區(qū)2010年城職和城居參保精神分裂癥患者的門診和住院醫(yī)療費(fèi)用及補(bǔ)償信息、門診特殊疾病統(tǒng)籌政策實(shí)施效果等相關(guān)資料，在此基礎(chǔ)上運(yùn)用規(guī)范分析法、統(tǒng)計(jì)學(xué)分析法、專家論證法等方法對所收集的數(shù)據(jù)和信息進(jìn)行分析。 研究結(jié)果 1．2010年武漢和杭州兩地精神分裂癥患者年人均門診次數(shù)分別為7.4次和21.9次，杭州、武漢兩地80%以上的門診患者流向二級(jí)、三級(jí)醫(yī)療機(jī)構(gòu)，杭州流向一級(jí)醫(yī)療機(jī)構(gòu)門診患者比重高于武漢流向一級(jí)醫(yī)療機(jī)構(gòu)門診患者比重。武漢和杭州兩地患者次均費(fèi)用分別為227.6元、268.9元，年人均費(fèi)用分別為2043.2元、5893.3元，分別占到當(dāng)?shù)厝司芍涫杖氲?.8%和19.6%。杭州門診患者次均費(fèi)用中藥物費(fèi)占95.9%，高于一般門診病人費(fèi)用的藥占比（50.9%）。 2.武漢城職門診患者年人均費(fèi)用（2062.8元）高于城居門診患者年人均費(fèi)用（1847.7元），當(dāng)?shù)爻锹氶T診患者實(shí)際補(bǔ)償比（76.7%）高于城居門診患者實(shí)際補(bǔ)償比（44.2%），杭州城職門診患者年人均費(fèi)用（5905.8元）高于城居門診患者年人均費(fèi)用（4939.9元），當(dāng)?shù)爻锹殞?shí)際補(bǔ)償比（84.1%）高于城居實(shí)際補(bǔ)償比（60.3%）；武漢城職、城居門診患者可報(bào)銷費(fèi)用占總費(fèi)用比重分別為78.7%和47.8%。武漢門診患者自付費(fèi)用影響因素有年齡、參保類型、就診次數(shù)、就診機(jī)構(gòu)級(jí)別。 3.武漢、杭州、長沙、無錫的城職住院患者年人均自付費(fèi)用分別為3475.1元、8781.1元、2796元、5183.7元，四地城居住院患者年人均自付費(fèi)用分別為4875.1元、10809元、13760.4元、5726.2元，，數(shù)據(jù)經(jīng)過校正后可發(fā)現(xiàn)門診特殊疾病統(tǒng)籌政策保障的人群的住院費(fèi)用較低。 4.2010年，武漢同時(shí)利用門診和住院服務(wù)的參保精神分裂癥患者人數(shù)為375人，占就診患者總?cè)藬?shù)的7.1%，這類患者年人均總醫(yī)療費(fèi)用13160.8元，年人均自付費(fèi)用4245.1元。杭州同時(shí)利用門診和住院服務(wù)的患者人數(shù)為344人，占就診患者總?cè)藬?shù)的9.4%，這類患者年人均總醫(yī)療費(fèi)用32760.6元，年人均自付醫(yī)療費(fèi)用7656.1元。 5.模擬在杭州普通門診統(tǒng)籌制度下就診于基層醫(yī)療機(jī)構(gòu)的精神分裂癥門診患者自付費(fèi)用，城職患者年均自付費(fèi)用1686.8元，城居患者年均自付費(fèi)用2155.9元，占精神分裂癥患者個(gè)人年均純收入的39.6%和50.5%。 研究結(jié)論 1.普通門診統(tǒng)籌制度保障能力有限，無法有效化解精神分裂癥患者費(fèi)用風(fēng)險(xiǎn)，患者自付費(fèi)用負(fù)擔(dān)過重，應(yīng)優(yōu)先納入精神分裂癥進(jìn)入門診特殊疾病統(tǒng)籌。 2.門診特殊疾病統(tǒng)籌政策化解精神分裂癥患者高額費(fèi)用風(fēng)險(xiǎn)，并促使患者減少住院服務(wù)利用，提高統(tǒng)籌基金使用效率；但也存在患者門診服務(wù)利用不足、藥物利用安全隱患、基層醫(yī)療機(jī)構(gòu)精神衛(wèi)生服務(wù)提供能力欠缺、補(bǔ)償方式的不合理、城職和城居制度公平性等問題，亟待改進(jìn)。 3.在精神分裂癥門診補(bǔ)償政策上，應(yīng)取消起付線，同時(shí)依據(jù)當(dāng)?shù)鼐裥l(wèi)生資源分布情況、結(jié)合精神分裂癥患者人群特點(diǎn)合理設(shè)置補(bǔ)償比例，引導(dǎo)患者合理就醫(yī)，門診特殊疾病統(tǒng)籌封頂線可與住院累計(jì)設(shè)置，逐步提高保障水平。對定點(diǎn)醫(yī)療機(jī)構(gòu)采取按年度總額預(yù)付的支付方式，控制費(fèi)用過快增長；在基層醫(yī)療服務(wù)機(jī)構(gòu)精神衛(wèi)生服務(wù)提供能力不足的情況下，門診特殊疾病統(tǒng)籌定點(diǎn)醫(yī)療機(jī)構(gòu)政策可適當(dāng)放寬；基藥目錄可適當(dāng)增加新型抗精神病藥物，康復(fù)治療項(xiàng)目應(yīng)逐步納入報(bào)銷目錄。此外，應(yīng)出臺(tái)針對精神分裂癥患者參加門診特殊疾病統(tǒng)籌的醫(yī)療救助政策。
[Abstract]:Purpose of study

On the basis of understanding the medical and health service utilization situation , medical expense burden and medical insurance policy compensation in outpatients with schizophrenia , this paper discusses the existing problems of medical service utilization in outpatient clinic and the effect of medical insurance compensation on medical expense expenditure , medical behavior and fund operation of the patient , demonstrates the necessity of integration of schizophrenia into outpatient special disease and the rationality of various decision - making in the compensation mode of outpatient special diseases , and puts forward the policy suggestion of more targeted medical insurance compensation mode .

Research Methods

Through a retrospective data survey method , a typical questionnaire survey , an intimate interview and so on , the data and information collected were analyzed by means of canonical analysis method , statistical analysis method , expert demonstration method and so on .

Results of the study

1 . In 2010 , the number of outpatient clinics in Wuhan and Hangzhou were 7.4 times and 21 . 9 times , respectively , and the proportion of outpatients with more than 80 % of outpatients in Hangzhou and Wuhan was higher than that in Wuhan .

2 . The annual per capita expenditure ( 2062.08 yuan ) of the outpatient clinic in Wuhan city was higher than the annual per capita expenditure ( 1847 . 7 yuan ) in the outpatient clinic of the city , and the actual compensation ratio ( 76.7 % ) was higher than the actual compensation ratio ( 44.2 % ) in the outpatient clinic of the city , and the annual per capita cost ( 5905 . 8 yuan ) of the outpatient clinic in Hangzhou city was higher than that of the city resident outpatient service ( 4939.9 yuan ) , and the actual compensation ratio ( 84.1 % ) in the local town was higher than the actual compensation ratio ( 60.3 % ) .
In Wuhan city , the proportion of the expenses of the outpatient department in the outpatient department of Wuhan was 78.7 % and 47.8 % , respectively . The factors influencing the self - payment of Wuhan outpatient department were the age , the type of reference , the number of visits and the level of the medical institution .

3 . In Wuhan , Hangzhou , Changsha and Wuxi , the annual per capita deductible expenses were RMB 3,75.1 yuan , 8781 . 1 yuan , 2796 yuan , 5183 . 7 yuan , respectively , and the annual per capita self - payment cost of the four urban residential houses was 4875.1 yuan , 10,809 yuan , 13760.4 yuan and 5726.2 yuan , respectively .

4 . In 2010 , the number of patients with schizophrenia treated with outpatient and inpatient services was 375 , accounting for 7.1 % of the total number of patients . The total annual per capita medical expense for this type of patient was CNY 13,160.8 , and the annual per capita self - payment expense was CNY 4,245.1 . In Hangzhou , the total number of patients with outpatient and inpatient services was 344 , accounting for 9.4 % of the total number of patients , and the total medical expense per capita in this type of patients was 32760.6 Yuan , and the annual per capita self - payment medical expense was RMB 766.1 Yuan .

5 . To simulate the self - payment of schizophrenia outpatients visiting the grass - roots medical institutions under the general outpatient service system of Hangzhou , the annual average self - payment of the city - office patients was RMB 1,86.8 yuan , and the annual average self - payment of the urban living patients was 2155.9 yuan , accounting for 39.6 % and 50.5 % of the individual annual income of the schizophrenic patients .

Conclusions of the study

1 . The limited capacity of the general outpatient planning system can not effectively resolve the cost risk of the schizophrenia patients , and the patient ' s self - payment expense is too heavy and should be given priority to the integration of schizophrenia into the outpatient special disease .

2 . To reduce the risk of high - level expenses in schizophrenic patients by the integrated policy of outpatient special diseases , and to promote the use of inpatient services and improve the efficiency of the use of integrated funds ;
However , there are some problems such as insufficient utilization of outpatient service , potential safety hazard of drug use , lack of ability of mental health service in grass - roots medical institutions , unreasonable compensation mode , fairness of city office and urban residence system , etc .

3 . In case of schizophrenia outpatient compensation policy , the pay - off line should be cancelled , according to the distribution of local mental health resources , the proportion of compensation should be reasonably set according to the characteristics of the population in the schizophrenia , so as to guide the patient to take a reasonable medical treatment , and the integrated sealing line of the outpatient special disease can be set up with the hospital accumulation gradually , so as to gradually improve the guarantee level . The fixed - point medical institution shall adopt the payment method paid in advance according to the total annual total , and the control cost is increased rapidly ;
Under the condition of insufficient capacity of the mental health service of the grass - roots medical service institutions , the policy of the outpatient special disease integrated fixed - point medical institution can be relaxed properly ;
The base - drug catalogue can properly add new antipsychotic drugs , and rehabilitation therapy projects should be gradually incorporated into the reimbursement directory . In addition , a medical assistance policy should be introduced for the treatment of schizophrenia patients to participate in outpatient special diseases .

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R197.32;R749.3

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