本文選題：公益性　切入點(diǎn)：醫(yī)療服務(wù)定價(jià)　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:針對(duì)我國醫(yī)療服務(wù)價(jià)格體系存在的問題,本文圍繞著“公立醫(yī)院公益性”,探索醫(yī)療服務(wù)定價(jià)的新思路,從而為政府進(jìn)一步理順醫(yī)療服務(wù)比價(jià)關(guān)系提供指導(dǎo)。方法:對(duì)已有的文獻(xiàn)資料進(jìn)行歸納整理,同時(shí)結(jié)合專家訪談法,根據(jù)專家訪談的意見對(duì)需要進(jìn)行調(diào)查的問卷加以改進(jìn)完善,初步擬定專家咨詢問卷;通過三輪專家咨詢法,分別針對(duì)醫(yī)療服務(wù)項(xiàng)目的醫(yī)學(xué)準(zhǔn)則剛性、活勞動(dòng)強(qiáng)度,對(duì)醫(yī)療服務(wù)項(xiàng)目指標(biāo)進(jìn)行分類,在完成分類的基礎(chǔ)上制定不同定價(jià)原則;使用專家的積極系數(shù)、權(quán)威程度以及協(xié)調(diào)系數(shù)來說明醫(yī)療服務(wù)指標(biāo)分類的科學(xué)與可靠性;利用SPSS21.0軟件,應(yīng)用t檢驗(yàn)探討分析腔鏡手術(shù)與傳統(tǒng)開刀手術(shù)的手術(shù)室費(fèi)用結(jié)構(gòu)情況,從而進(jìn)一步反映目前的醫(yī)療服務(wù)比價(jià)關(guān)系狀況。結(jié)果:經(jīng)過三輪專家咨詢,分別針對(duì)醫(yī)療服務(wù)項(xiàng)目的醫(yī)學(xué)準(zhǔn)則剛性、活勞動(dòng)強(qiáng)度完成了43個(gè)指標(biāo)的分類。其中,第一輪專家的積極系數(shù)分別為97.44%,第二輪專家的積極系數(shù)為94.06%,第三輪專家的積極系數(shù)為100.00%;專家權(quán)威程度為0.8490。第一輪專家咨詢中指標(biāo)的醫(yī)學(xué)準(zhǔn)則剛性和活勞動(dòng)強(qiáng)度的專家協(xié)調(diào)系數(shù)分別為0.626(X~2=985.428,PO.001)和0.431(X~2=670.353,PO.001);第二輪專家咨詢中指標(biāo)的醫(yī)學(xué)準(zhǔn)則剛性和活勞動(dòng)強(qiáng)度的專家協(xié)調(diào)系數(shù)分為0.597(X~2=998.125,PO.001)和0.527(X~2=650.218,PO.001);第三輪專家咨詢中指標(biāo)的醫(yī)學(xué)準(zhǔn)則剛性和活勞動(dòng)強(qiáng)度的專家協(xié)調(diào)系數(shù)分為0.538(X~2=1028.511,PO.001)和0.460(X~2=636.947,PO.001)。另外,通過對(duì)所調(diào)取的常見手術(shù)的手術(shù)室費(fèi)用及結(jié)構(gòu)進(jìn)行分析,同醫(yī)療服務(wù)價(jià)格調(diào)整前相比較,在青島市醫(yī)療服務(wù)價(jià)格調(diào)整后的手術(shù)室總費(fèi)用中,手術(shù)費(fèi)、麻醉費(fèi)等技術(shù)勞務(wù)費(fèi)均有增加,而且從費(fèi)用結(jié)構(gòu)來看,技術(shù)勞務(wù)費(fèi)的構(gòu)成比上漲是較大的,而一次性耗材的費(fèi)用及其所占手術(shù)室費(fèi)用的比例是明顯下降的,此外,檢查、監(jiān)測費(fèi)也是略有下降的。但是,一次性耗材費(fèi)、檢查、監(jiān)測等非技術(shù)勞務(wù)費(fèi)及其比例仍明顯高于技術(shù)勞務(wù)費(fèi),其中以一次性耗材費(fèi)最為顯著。結(jié)論:在按項(xiàng)目收費(fèi)的現(xiàn)實(shí)前提下,為醫(yī)學(xué)準(zhǔn)則剛性強(qiáng)的醫(yī)療服務(wù)項(xiàng)目構(gòu)筑經(jīng)濟(jì)空間,有利于激勵(lì)醫(yī)療服務(wù)供給者的公益性行為;對(duì)醫(yī)學(xué)準(zhǔn)則剛性弱、醫(yī)生自由選擇程度大的醫(yī)療服務(wù)項(xiàng)目實(shí)行縮小收益空間,甚至收益接近于(等于)或小于成本的定價(jià),有助于引導(dǎo)醫(yī)療服務(wù)提供者堅(jiān)持以患者為中心,根據(jù)醫(yī)療需要,而不是根據(jù)經(jīng)濟(jì)利益獲取的公益性行為;醫(yī)療服務(wù)價(jià)格的調(diào)整雖然進(jìn)一步理順了醫(yī)療服務(wù)比價(jià)關(guān)系,但是關(guān)于醫(yī)務(wù)人員的技術(shù)勞務(wù)價(jià)值還有待于進(jìn)一步合理體現(xiàn)。
[Abstract]:Objective: in view of the problems existing in the price system of medical services in China, this paper focuses on the "public welfare of public hospitals" and explores a new way of pricing medical services. So as to provide guidance for the government to further straighten out the relationship between medical services and price. Methods: the existing literature and materials are summarized and sorted, and the questionnaire that needs to be investigated is improved and perfected according to the opinions of expert interviews and combined with the method of expert interviews. Through three rounds of expert consultation, aiming at the rigidity of medical standards and the intensity of living labor of medical service items, the indexes of medical service items are classified, and different pricing principles are worked out on the basis of the classification. The positive coefficient of experts, the degree of authority and the coordination coefficient are used to explain the scientific and reliability of the classification of medical service index, and the cost structure of operating room for endoscopic surgery and traditional operation is analyzed by using SPSS21.0 software and t-test. Results: after three rounds of expert consultation, 43 indexes were classified according to the rigidity of medical standards and live labor intensity of medical service items. The positive coefficient of experts in the first round is 97.44, the positive coefficient in the second round is 94.06 and the positive coefficient in the third round is 100.00.The degree of authority of the experts is 0.8490. The coordination coefficient of experts is 0.626 X ~ (2 +) ~ (985.428) (P _ (001)) and 0.431X ~ (2) ~ (2) ~ (67) 0.353 ~ (3) P _ (001); the coefficient of expert coordination for the rigidity of medical criteria and the intensity of live labor for the indicators in the second round of expert consultation are 0.597X ~ (2) (998.125PO. 001) and 0.52727X _ (2) (650.2N _ (650.218PO _ (001)); the rigidity of medical criteria and the intensity of live labor in the third round of expert consultation. The expert coordination coefficients of the two groups are 0.538, XX, 1028.511, PO.001, and 0.460, XG, 2636.947, PO.001. in addition, By analyzing the operating room cost and structure of the common operation, compared with that before the adjustment of the medical service price, the operating expenses of the operating room after the adjustment of the medical service price in Qingdao City were analyzed. The cost of technical services, such as anesthesia, has increased, and in terms of the cost structure, the composition of the cost of technical labour is higher, while the cost of disposable consumables and their share in operating room costs have decreased significantly. In addition, inspections, However, non-technical labor costs, such as one-time consumables, inspections, monitoring, and their proportion are still significantly higher than those of technical labour. Conclusion: under the realistic premise of charging according to the project, the economic space for the medical service project with strong rigidity is built, which is helpful to encourage the public welfare behavior of the medical service provider. A narrowing of revenue space or even pricing of benefits close to (equal to) or less than the cost of medical services, which are weak in the rigidity of medical guidelines and a large degree of doctor's free choice, can help to guide medical service providers to adhere to patient-centered approaches. According to the medical needs, not the public welfare behavior obtained according to the economic benefits; the adjustment of the medical service price has further straightened out the relationship between the medical service price and the medical service price. However, the technical labor value of medical personnel needs to be further and reasonably reflected.
【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】：2017
【分類號(hào)】：R197.1

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本文編號(hào)：1613980